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Question 1
Correct
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A 50 year old female patient with an history of chronic headache was scheduled for CT scan. If the CT scan revealed a tumour at the horn of the lateral ventricle, which of the following structures is most likely to be compressed by this tumour?
Your Answer: Fibres of the corpus callosum
Explanation:The ventricular system of the brain is made up of four ventricles namely; two lateral and a third and forth ventricle. The ventricles are the site of the development of the cerebrospinal fluid. The left and right lateral ventricles are located in each of the brain’s hemispheres. The roof of the lateral ventricles are made up of the fibres of the corpus callosum. This is the structure that would be compressed by the a tumour on the roof of the lateral ventricles.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 2
Correct
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A 15-year-old girl was diagnosed with bacterial meningitis. Gram staining of the spinal fluid shows numerous polymorphonuclear neutrophils and Gram-positive cocci. Which is the empiric drug of choice to be given to the patient until the antibiotic sensitivity report is available?
Your Answer: Ceftriaxone
Explanation:Acute meningitis is a medical emergency. All suspects should receive their first dose of antibiotics immediately and be transferred to hospital as soon as possible. If facilities for blood culture and/or lumbar puncture (LP) are immediately available, they should be performed before administration
of the first dose of antibiotics (see contraindications to LP below). Neither procedure should lead to a significant delay in antibiotic administration.
Administer ceftriaxone 80-100 mg/kg (maximum 2 g, 12 hourly) intravenously. The intramuscular or intraosseous route can be used if there is no vascular access. Penicillin allergy is not a contraindication to ceftriaxone in acute meningitis (C-1). Omit ceftriaxone only if there has been documented ceftriaxone anaphylaxis. Give chloramphenicol 25 mg/kg (maximum 500 mg) intravenously instead, if available. Administer adequate analgesia and transfer the patient immediately to hospital, detailing all administered
medication in the referral letter. -
This question is part of the following fields:
- Microbiology
- Pathology
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Question 3
Correct
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A 50-year-old gentleman was recently diagnosed with hypertension, with no other abnormalities on physical examination. Further investigations revealed the following :
Na+ 144 mmol/l
K+ 3.0 mmol/l
Cl- 107 mmol/l
Bicarbonate 25 mmol/l.
Blood glucose 5.8 mmol/l.
What is the likely diagnosis?Your Answer: Conn syndrome
Explanation:Overproduction of aldosterone (a mineralocorticoid) by the adrenal glands is known as Conn’s syndrome. It can be either due to an aldosterone-secreting adrenal adenoma (50-60% cases) or adrenal gland hyperplasia (40-50% cases). Excess aldosterone leads to sodium and water retention, along with potassium excretion. This leads to arterial (non-essential) hypertension. Conn’s syndrome is the commonest cause of primary hyperaldosteronism. Other symptoms include muscle cramps, headache (due to hypokalaemia) and metabolic alkalosis, which occurs due to increased secretion of H+ ions by the kidney. The raised pH of the blood traps calcium leading to symptoms of hypocalcaemia, which can be mimicked by liquorice ingestion and Liddle syndrome. To diagnose Conn’s syndrome, the ratio of renin and aldosterone is measured. Due to suppression of renin secretion, there is low renin to aldosterone ratio (<0.05). However, anti-hypertensives may affect the test results and should be withdrawn for 6 weeks. Computed tomography can also be done to detect the presence of adrenal adenoma. Cushing’s syndrome does not cause hypokalaemia with normal serum glucose levels. Nelson’s syndrome refers to increased ACTH secretion due to pituitary adenoma. Pheochromocytoma will not lead to hypokalaemia even though hypertension can be seen.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 4
Correct
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A 57-year-old male smoker noted a lump on his inner lip. Upon physical examination the lump measured more than 2 cm but less than 4 cm in its greatest dimension. He is diagnosed with squamous cell carcinoma of the lip. What is the stage of the patient's cancer according to the TNM staging for head and neck cancers?
Your Answer: T2
Explanation:Head and neck cancer is a group of cancers that starts within the mouth, nose, throat, larynx, sinuses, or salivary glands. The TNM staging system used for head and neck cancers is a clinical staging system that allows physicians to compare results across patients, assess prognosis, and design appropriate treatment regimens. The staging is as follows; Primary tumour (T): Tis: pre-invasive cancer (carcinoma in situ), T0: no evidence of primary tumour, T1: tumour 2 cm or less in its greatest dimension, T2: tumour more than 2 cm but not more than 4 cm, T3: tumour larger than 4 cm, T4: tumour with extension to bone, muscle, skin, antrum, neck, etc and TX: minimum requirements to assess primary tumour cannot be met. Regional lymph node involvement (N): N0: no evidence of regional lymph node involvement, N1: evidence of involvement of movable homolateral regional lymph nodes, N2: evidence of involvement of movable contralateral or bilateral regional lymph nodes, N3: evidence of involvement of fixed regional lymph nodes and NX: Minimum requirements to assess the regional nodes cannot be met. Distant metastases (M): M0: no evidence of distant metastases, M1: evidence of distant metastases and MX: minimum requirements to assess the presence of distant metastases cannot be met. Staging: Stage I: T1 N0 M0, Stage II: T2 N0 M0, Stage III: T2NOMO and T3N1MO, Stage IV: T4N1M0, any TN2M0, any TN3M0, any T and any NM1. The depth of infiltration is predictive of the prognosis. With increasing depth of invasion of the primary tumour, the risk of nodal metastasis increases and survival decreases. The patient in this scenario therefore has a T2 tumour.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 5
Correct
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A patient gives a history of dull discomfort in her abdomen associated with pain that she points to be on her right shoulder and right scapula. The following organs are most likely to be source of her pain:
Your Answer: Liver, duodenum and gallbladder
Explanation:Referred pain is felt at a point away from the source of the pain or the unpleasant sensation. It arises when a nerve is damaged or compressed at a point but the pain is felt at another site that is the territory of that nerve. Common abdominal causes of referred pain to the shoulder and the shoulder blade are the liver, duodenum and gall bladder.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 6
Incorrect
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What is the likely course of a pulmonary embolism arising from the leg veins and ending in the apical segmental pulmonary artery that supplies the superior lobe of left lung?.
Your Answer: Inferior vena cava – right atrium – tricuspid valve – right ventricle – pulmonary trunk – left pulmonary artery – left bronchial artery – left apical segmental artery
Correct Answer: Inferior vena cava – right atrium – tricuspid valve – right ventricle – pulmonary trunk – left pulmonary artery – left superior lobar artery – left apical segmental artery
Explanation:A clot originating in the leg vein will go to the inferior vena cava, into the right atrium, through the tricuspid valve, into the right ventricle, through the pulmonary trunk, into the left pulmonary artery, into the left superior lobar artery and then finally reach the left apical segmental artery.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 7
Correct
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Which of these infectious agents tends to affect people under 20 and over 40 years old, can cause acute encephalitis with cerebral oedema and petechial haemorrhages, along with haemorrhagic lesions of the temporal lobe. A lumbar puncture will reveal clear cerebrospinal fluid with an elevated lymphocyte count?
Your Answer: Herpes simplex virus
Explanation:Haemorrhagic lesions of the temporal lobe are typical of Herpes simplex encephalitis (HSE). It tends to affect patients aged under 20 or over 40 years, and is often fatal if left untreated. In acute encephalitis, cerebral oedema and petechial haemorrhages occur and direct viral invasion of the brain usually damages neurones. The majority of cases of herpes encephalitis are caused by herpes simplex virus-1 (HSV-1), and about 10% of cases of herpes encephalitis are due to HSV-2, which is typically spread through sexual contact.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 8
Incorrect
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Which cells are most commonly seen in a granulomatous lesion that suggests an underlying chronic inflammation?
Your Answer: Mast cells
Correct Answer: Lymphocytes
Explanation:Lymphocytes and monocytes are commonly and characteristically recognised in a case of chronic inflammation.
Eosinophils and neutrophils are seen with acute inflammation.
Mast cells release histamine in early inflammation.
Basophils are seen with allergies.
Plasma cells are seen with viral infection.
Platelets are not characteristic of any type of inflammation.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 9
Correct
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A 56-year-old woman weighs 75 kg. In this patient, total body water, intracellular fluid and extracellular fluid are respectively:
Your Answer: 45 l, 30 l, 15 l
Explanation:The percentages of body water contained in various fluid compartments add up to total body water (TBW). This water makes up a significant fraction of the human body, both by weight and by volume. The total body water (TBW) content of humans is approximately 60% of body weight. Two-thirds is located in the intracellular and one-third in the extracellular compartment. So, in a 75-kg individual, TBW = 60 × 75/100 = 45 l. Intracellular content = 2/3 × 45 = 30 l and extracellular content = 1/3 × 45 = 15 l.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 10
Correct
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Diuretics that act on the ascending limb of the loop of Henle produce:
Your Answer: Reduced active transport of sodium
Explanation:The loop of Henlé leads from the proximal convoluted tubule to the distal convoluted tubule. Its primary function uses a counter current multiplier mechanism in the medulla to reabsorb water and ions from the urine. It can be divided into four parts:
1. Descending limb of loop of Henlé – low permeability to ions and urea, while being highly permeable to water
2. Thin ascending limb of loop of Henlé – not permeable to water, but it is permeable to ions
3. Medullary thick ascending limb of loop of Henlé – sodium (Na+), potassium (K+) and chloride (Cl–) ions are reabsorbed by active transport. K+ is passively transported along its concentration gradient through a K+ channel in the basolateral aspect of the cells, back into the lumen of the ascending limb.
4. The cortical thick ascending limb – the site of action where loop diuretics such as furosemide block the K+/Na+/2Cl− co-transporters = reduced active transport.
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This question is part of the following fields:
- Physiology
- Renal
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Question 11
Correct
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During hysterectomy, the ureter is most likely to be ligated when a surgeon is clamping the?
Your Answer: Uterine arteries
Explanation:The ureter forms the posterior boundary of a shallow depression which lodges the ovary and then runs medially and forward on the lateral aspect of the uterine cervix and upper part of the vagina to reach the fundus of the bladder. It is also situated about 2cm from the side of the cervix of the uterus. The relationship of the ureters and uterine arteries is of clinical significance because the arteries are at risk of iatrogenic injury during hysterectomy.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 12
Correct
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A patient is diagnosed with Brucellosis. What is the mode of transmission of this disease?
Your Answer: Unpasteurised milk
Explanation:Brucellosis is a highly contagious zoonosis caused by ingestion of unpasteurized milk or undercooked meat from infected animals, or close contact with their secretions.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 13
Correct
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A 45-year-old-female is suspected to have a pulmonary mass. Supposing that she has a neoplasm, which of the following are most commonly found to involve the lung:
Your Answer: Pulmonary metastases
Explanation:Lung metastases occur when a cancer started in another part of the body (primary site) spreads to the lungs. The lungs are among the most common site where cancer can spread due to its rich systemic venous drainage, almost every type of cancer can spread to the lung. The most common types of cancer that spread to the lung are breast, colorectal, kidney, testicular, bladder, prostate, head and neck cancers.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 14
Incorrect
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The annular ligament in the forearm:
Your Answer: Goes from the olecranon fossa to the olecranon process
Correct Answer: Encircles the head of the radius
Explanation:The annular ligament forms about four-fifths of the osseofibrous ring and is attached to the anterior and posterior margins of the radial notch. It is a strong band of fibres which encircles the head of the radius retaining it in contact with the radial notch of the ulna. When it comes to its upper border, it blends with the anterior and posterior ligament of the elbow.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 15
Correct
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A 60-year-old woman has had persistent diarrhoea for a week. A stool test reveals an infection by Clostridium difficile. Which of the following antibiotics could be used to treat the infection?
Your Answer: Oral vancomycin
Explanation:Three antibiotics are effective against Clostridium difficile:
Metronidazole 500 mg orally three times daily is the drug of choice, because of superior tolerability, lower price and comparable efficacy.
Oral vancomycin 125 mg four times daily is second-line therapy in particular cases of relapse or where the infection is unresponsive to metronidazole treatment.
Thirdly, the use of linezolid might also be considered.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 16
Correct
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Out of the following options, which malignancy has the highest potential for multicentricity?
Your Answer: Transitional cell carcinoma
Explanation:Transitional cell carcinomas can arise anywhere in the urothelium lining the urinary tract; and hence are known to be multicentric and recur commonly. Prostatic adenocarcinoma most commonly involves the posterior lobe of the prostate gland. Although renal cell carcinomas occasionally show multicentricity, it is not common. Penile carcinomas are usually locally infiltrative lesions. Wilm’s tumours are usually solitary, but can be bilateral or multicentric in 10% cases. Small cell carcinoma of lung and teratomas are usually solitary.
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This question is part of the following fields:
- Pathology
- Renal
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Question 17
Correct
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A 26-year-old female patient had the following blood report: RBC count = 4. 0 × 106/μl, haematocrit = 27% and haemoglobin = 11 g/dl, mean corpuscular volume (MCV) = 90 fl, mean corpuscular haemoglobin concentration (MCHC) = 41 g/dl. Further examination of blood sample revealed increased osmotic fragility of the erythrocytes. Which of the following is the most likely cause of this patient’s findings?
Your Answer: Spherocytosis
Explanation:Spherocytes are small rounded RBCs. It is due to an inherited defect of the RBC cytoskeleton membrane tethering proteins. Membrane blebs form that are lost over time and cells become round instead of biconcave. As it is a normochromic anaemia, the MCV is normal. it is diagnosed by osmotic fragility test which reveals increased fragility in a hypotonic solution.
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This question is part of the following fields:
- General
- Physiology
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Question 18
Incorrect
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If a tumour is found in both lobes of the prostate, without nodal involvement or metastases, a histological grade of G2 and elevated PSA, what is the overall prostatic cancer stage?
Your Answer: Stage III
Correct Answer: Stage II
Explanation:The AJCC uses the TNM, Gleason score and PSA levels to determine the overall stage of prostatic cancer. This staging is as follows:
Stage I: T1, N0, M0, Gleason score 6 or less, PSA less than 10; or T2a, N0, M0, Gleason score 6 or less, PSA less than 10
Stage IIa: T1, N0, M0, Gleason score of 7, PSA less than 20; or T1, N0, M0, Gleason score of 6 or less, PSA at least 10 but less than 20; or T2a or T2b, N0, M0, Gleason score of 7 or less, PSA less than 20
Stage IIb: T2c, N0, M0, any Gleason score, any PSA; or T1 or T2, N0, M0, any Gleason score PSA of 20 or more; or T1 or T2, N0, M0, Gleason score of 8 or higher, any PSA
Stage III: T3, N0, M0, any Gleason score, any PSA Stage IV: T4, N0, M0,any Gleason score, any PSA; or any T, N1, M0,any Gleason score, any PSA; or Any T, any N, M1, any Gleason score, any PSA.
The patient in this case has a T2 N0 M0 G2 tumour, meaning it belongs in stage II
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This question is part of the following fields:
- Pathology
- Urology
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Question 19
Incorrect
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A surgeon trainee is assisting in an operation to ligate the ductus arteriosus. The consultant supervising explains that caution is required when placing a clamp on the ductus to avoid injury to an important structure immediately dorsal to it. To which structure is the consultant referring?
Your Answer: Accessory Hemiazygous vein
Correct Answer: Left recurrent laryngeal nerve
Explanation:The left recurrent laryngeal nerve branches off the vagus and wraps around the aorta, posterior to the ductus arteriosus/ligamentum arteriosum from whence it courses superiorly to innervate the laryngeal muscles.
Accessory Hemiazygous vein is on the left side of the body draining the posterolateral chest wall and emptying blood into the azygos vein.
The left internal thoracic artery is branch of the left subclavian artery supplying blood to the anterior wall of the thorax.
Left phrenic nerve is lateral to the vagus nerve.
Thoracic duct: is behind the oesophagus, coursing between the aorta and the azygos vein in the posterior chest.
Right recurrent laryngeal nerve: loops around the right subclavian artery and is not in danger in this procedure.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 20
Incorrect
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Which of the following organs of the abdominal cavity is completely covered by the peritoneum?
Your Answer: Kidney
Correct Answer: Spleen
Explanation:Of the organs listed, the spleen is the only organ that is completely intraperitoneal, that is entirely in the peritoneum. Other completely intraperitoneal organs include the stomach, liver, appendix and the small intestines. The kidney, Inferior vena cava, aorta and the suprarenal glands are all retroperitoneal organs. The pancreas and the duodenum are partially retroperitoneal, with the tail of the pancreas in the peritoneum found in the splenorenal ligament while only the first part of the duodenum is intraperitoneal. For the intraperitoneal organs remember SALTD SPRSS
S = Stomach
A = Appendix
L = Liver
T = Transverse colon
D = Duodenum (only the 1st part)
S = Small intestines
P = Pancreas (only the tail)
R = Rectum (only the upper 3rd)
S = Sigmoid colon
S = Spleen
For retroperitoneal, just remember SADPUCKER:
S = suprarenal glands
A = Aorta and IVC
D = Duodenum (all but the 1st part)
P = Pancreas (all but the tail)
U = Ureter and bladder
C = Colon (ascending and descending)
K = Kidneys
E = Oesophagus
R = Rectum (Lower two-thirds)
For secondarily retroperitoneal remember ‘Pussy Cat Dolls“:
P = Pancreas
C = Colon (only ascending and descending)
D = Duodenum (only parts 2-4) -
This question is part of the following fields:
- Abdomen
- Anatomy
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Question 21
Correct
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Depression of the normal coagulation system and excessive bleeding after surgery can occur in which of the following medical conditions?
Your Answer: Liver disease
Explanation:As most of the coagulation factors are synthesized in the liver, liver diseases like hepatitis or cirrhosis will depress the coagulation system. Vitamin K deficiency can also decrease the production of vitamin K dependent coagulation factors VII, XI, X and prothrombin.
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This question is part of the following fields:
- General
- Physiology
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Question 22
Incorrect
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Skeletal muscle fibres are divided into two basic types, type I (slow-twitch fibres) and type II (fast-twitch fibres). Fast muscle fibres do which of the following:
Your Answer: Have numerous mitochondria
Correct Answer: Use anaerobic metabolism
Explanation:Skeletal muscles are divided into two types:
1) type I also known as the slow twitch fibres. They use oxygen for their metabolism and as a result they have a high endurance potential. To support this they have abundant mitochondria and myoglobin, so they appear red/dark.
2) type II fibres also called fast twitch fibres, are low endurance fibres used during anaerobic metabolism. They are required for short bursts of strength and cannot sustain contractions for long periods of time.
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This question is part of the following fields:
- General
- Physiology
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Question 23
Correct
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A 60-year old woman who has a left sided post-pneumonic effusion, was to have some pleural fluid aspirated for culture and sensitivity. If the medical intern in charge of the procedure decided to aspirate while the patient is sitting up on her bed, where in the pleural cavity would the fluid tend to accumulate?
Your Answer: Costodiaphragmatic recess
Explanation:The lowest part of the pleural cavity is the costodiaphragmatic recess and it the space in which the pleural fluid will accumulate when the patient sits up.
The cupola is part of the pleural cavity that extends into the root of the neck above the first rib.
The costomediastinal recess is the junction at which the costal pleura becomes the mediastinal pleura.
The middle mediastinum is the part of the mediastinum that is occupied by the heart.
The hilar reflection is the point where the mediastinal pleura is reflected to continue on as the visceral pleura.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 24
Correct
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A 70-year old man presents to the surgical out patient clinic with a direct inguinal hernia on the right side. He had undergone and appendicectomy 6 months prior. The examining doctor correlated the development of the hernia to iatrogenic nerve injury that happened during the operation. Which nerve had been injured?
Your Answer: Ilioinguinal
Explanation:Direct inguinal hernias occur because of weakness in the abdominal muscles. The ilioinguinal nerve is important for innervating the muscles of the lower abdominal wall and damage during appendicectomy therefore prevents the man from being able to contract abdominal muscles to pull the falx inguinalis over the weak fascia.
The genitofemoral nerve innervates the cremaster muscle and injury to it would cause inability to elevate the testes.
The subcostal nerve and the ventral primary ramus of T10 innervate the muscles, skin and fascia of the upper abdominal wall.
The iliohypogastric nerve supplies the skin over the upper part of the buttock behind the area supplied by the subcostal nerve.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 25
Correct
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Which one of the following muscles is innervated by the facial nerve?
Your Answer: Buccinator
Explanation:Buccinator is a muscle of facial expression and is therefore innervated by the facial nerve. The lateral pterygoid, masseter, anterior belly of digastric and temporalis are all muscles of mastication and therefore innervated by the mandibular division of the trigeminal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck; Neurology
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Question 26
Incorrect
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Where do the cells belonging to the mononuclear phagocyte system originate?
Your Answer: Lymph nodes
Correct Answer: Bone marrow
Explanation:The macrophage originates from a committed bone marrow stem cell. It is called the pluripotent hematopoietic stem cell. This differentiates into a monoblast and then into a promonocyte and finally matures into a monocyte. When called upon they leave the bone marrow and enter into the circulation. Upon entering the tissue they transform into macrophages. Tissue macrophages include: Kupffer cells (liver), alveolar macrophages (lung), osteoclasts (bone), Langerhans cells (skin), microglial cells (central nervous system), and possibly the dendritic immunocytes of the dermis, spleen and lymph nodes.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 27
Incorrect
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Which organs amongst these are the derivatives of the endoderm?
Your Answer: Lens
Correct Answer: Epithelial part of the tympanic cavity
Explanation:Endoderm derivatives include the epithelium of the following: gastrointestinal tract and its glands, glandular cells of the liver and pancreases, urachus and urinary bladder, pharynx, trachea and alveoli, part of the tonsils, thyroid and parathyroid, tympanic cavity and thymus and part of the anterior pituitary gland.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 28
Incorrect
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A 16 year old girl fractured a bone in her left foot. Upon examination the clinician discovered that the fracture affected the insertion of the peroneus brevis muscle. Which of the following bones was most likely affected?
Your Answer: Navicular
Correct Answer: Base of the fifth metatarsal
Explanation:The peroneus brevis muscle originates from the lower two-thirds of the lateral body of the fibula and has inserts at the base of the fifth metatarsal. Fractures to this bone are common and can be due to infection, trauma, overuse and repetitive use.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 29
Incorrect
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When one is silently counting, what part of his brain will show increased regional cerebral blood flow (rCBF)?
Your Answer: Medial temporal lobe
Correct Answer: Supplementary motor area
Explanation:Regional cerebral blood flow (rCBF) increases in the superior speech cortex (supplementary motor area) during periods of silent counting, whereas speaking aloud will do so in the motor cortex and medial temporal lobe, along with the superior speech cortex.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 30
Incorrect
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Which of the following arteries is the posterior branch of the external carotid artery?
Your Answer: Occipital
Correct Answer: Superficial temporal
Explanation:The external carotid artery is a branch of the common carotid artery that supplies parts of the neck, head and face. It branches off from the common carotid artery at the level of the thyroid cartilage. The external carotid, at the level of the mandible divides into the maxillary artery and the superficial temporal. The superficial temporal artery is the posterior branch of these two arteries. It starts off, somewhat, as a continuation of the external carotid artery at the substance of the parotid gland. Anterior cerebral and middle cerebral arteries are branches of the internal carotid artery.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 31
Correct
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Painful erections along with deviation of the penis to one side when erect are seen in which of the following conditions?
Your Answer: Peyronie’s disease
Explanation:Peyronie’s disease leads to development of fibrous plaques in the penile soft tissue and occurs in 1% of men, most commonly affecting white males above 40 years age. It is a connective tissue disorder named after a French surgeon, François de la Peyronie who first described it. Symptoms include pain, hard lesions on the penis, abnormal curvature of erect penis, narrowing/shortening, painful sexual intercourse and in later stages, erectile dysfunction. 30% cases report fibrosis in other elastic tissues such as Dupuytren’s contractures of the hand. There is likely a genetic predisposition as increased incidence is noted among the male relatives of an affected individual.
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This question is part of the following fields:
- Pathology
- Urology
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Question 32
Correct
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A patient is diagnosed with a tumour of the parotid gland. During surgical removal of the gland, which artery is vulnerable to injury?
Your Answer: External carotid artery
Explanation:The external carotid artery is a major artery of the head and neck. It arises from the common carotid artery when it splits into the external and internal carotid artery. It supplies blood to the face and neck. The external carotid artery begins opposite the upper border of the thyroid cartilage and, taking a slightly curved course, passes upward and forward and then inclines backward to the space behind the neck of the mandible, where it divides into the superficial temporal and internal maxillary arteries. It rapidly diminishes in size in its course up the neck, owing to the number and large size of the branches given off from it. At its origin, this artery is more superficial and placed nearer the midline than the internal carotid and is contained within the carotid triangle. The external carotid artery is covered by the skin, superficial fascia, platysma, deep fascia and anterior margin of the sternocleidomastoid. It is crossed by the hypoglossal nerve, by the lingual, ranine, common facial and superior thyroid veins; and by the digastric and stylohyoid; higher up it passes deeply into the substance of the parotid gland, where it lies deep to the facial nerve and the junction of the temporal and internal maxillary veins. It is here that it is in danger during surgery of the parotid gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 33
Incorrect
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Chronic obstructive pulmonary disease (COPD) is likely to result in:
Your Answer: Respiratory alkalosis
Correct Answer: Respiratory acidosis
Explanation:COPD leads to respiratory acidosis (chronic). This occurs due to hypoventilation which involves multiple causes, such as poor responsiveness to hypoxia and hypercapnia, increased ventilation/perfusion mismatch leading to increased dead space ventilation and decreased diaphragm function.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 34
Incorrect
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If your EEG shows waves with a frequency range of 8-12 Hz, the waves most likely to be seen are:
Your Answer: Beta
Correct Answer: Alpha
Explanation:Electroencephalography (EEG) is the neurophysiological measurement of the electrical activity of the brain. It is done by placing electrodes on the scalp or subdurally. In reality, the electrical currents are not measured, but rather the voltage differences between different parts of the brain. Four major types of EEG activity are recognized, which are alpha, beta, delta and theta.
Alpha waves, also known as Berger’s waves ranges in frequency from 8-12 Hz. Best detected with eyes closed, alpha waves are characteristic of a relaxed, alert state of consciousness. An alpha-like normal variant called mu is sometimes seen over the motor cortex (central scalp) and attenuates with movement or, rather, with the intention to move.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 35
Incorrect
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A 40-year old gentleman, who is a known with ulcerative colitis, complains of recent-onset of itching and fatigue. On examination, his serum alkaline phosphatase level was found to be high. Barium radiography of the biliary tract showed a 'beaded' appearance. What is the likely diagnosis?
Your Answer:
Correct Answer: Sclerosing cholangitis
Explanation:Primary sclerosing cholangitis is characterised by patchy inflammation, fibrosis and strictures in intra- and extra-hepatic bile ducts. It is a chronic cholestatic condition with 80% patients having associated inflammatory bowel disease (likely to be ulcerative colitis). Symptoms include pruritus and fatigue. ERCP (endoscopic retrograde cholangiopancreatography) or MRCP (magnetic resonance cholangiopancreatography) are diagnostic. Disease can lead to complete obliteration of ducts, which can result in liver failure. Cholangiocarcinoma is also a recognised complication..
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 36
Incorrect
-
Different substances have different renal clearance rates. Which of the following substances should have the lowest renal clearance rate in a healthy patient?
Your Answer:
Correct Answer: Glucose
Explanation:Under normal conditions the renal clearance of glucose is zero, since glucose is completely reabsorbed in the renal tubules and not excreted. Glycosuria – the excretion of glucose into the urine- is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 37
Incorrect
-
A surgeon performing a thymectomy to remove a malignant thymoma is careful to avoid damaging an important nerve lying around the arch of the aorta. Which nerve is the surgeon trying to preserve?
Your Answer:
Correct Answer: Left Vagus
Explanation:The left vagus nerve lies on the lateral surface of the aortic arch. The left recurrent laryngeal nerve arises from the vagus and loops around the arch of the aorta. This nerve is at risk of injury during surgery.
The right and left phrenic nerves, being lateral to the vagus, do not loop around the arch of the aorta.
The sympathetic trunks, both right and left, are located in the posterior chest; not near the aortic arch.
The right vagus: not involved with the aortic arch.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 38
Incorrect
-
The most important difference between interstitial fluid and plasma is the:
Your Answer:
Correct Answer: Protein concentration
Explanation:Interstitial fluid (or tissue fluid or intercellular fluid) is a solution that surrounds the cells of multicellular animals. It is the main component of the extracellular fluid, which also includes plasma, lymph and transcellular fluid. Plasma, the major component in blood, communicates freely with interstitial fluid through pores and intercellular clefts in capillary endothelium. Interstitial fluid consists of a water solvent containing amino acids, sugars, fatty acids, coenzymes, hormones, neurotransmitters, salts, as well as waste products from the cells. Red blood cells, platelets and plasma proteins cannot pass through the walls of the capillaries. The resulting mixture that does pass through is essentially blood plasma without the plasma proteins. Tissue fluid also contains certain types of white blood cells. Once the extracellular fluid collects into small vessels it is considered to be lymph, and the vessels that carry it back to the blood are called the lymphatic vessels. The lymphatic system returns protein and excess interstitial fluid to the circulation.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 39
Incorrect
-
A 70-year old man who is suspected to have a perforated colonic diverticulum is explored in theatre through a midline incision. This incision will be through the:
Your Answer:
Correct Answer: Linea alba
Explanation:The linea alba is the point where this incision was made. It is a tendinous raphe in the midline of the abdomen extending between the xiphoid process and the symphysis pubis. It is placed between the medial borders of the recti and is formed by the blending of the aponeuroses of the external and internal obliques and transversi.
The linea aspera is a vertical ridge on the posterior surface of the femur.
The arcuate line is the inferior border of the posterior rectus sheath behind the rectus abdominis muscle.
The semilunar line is the lateral margin of the rectus abdominis.
The iliopectineal line is a line on the pelvic bones formed by the arcuate line of the ilium and the pectineal line of the pubis.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 40
Incorrect
-
The posterior cord contains nerve fibres from which of the following levels of the spinal cord?
Your Answer:
Correct Answer: C5, C6, C7, C8 and T1
Explanation:THE correct answer is A. The posterior cord derives its fibres from the spinal nerves C5,C6,C7,C8,T1. This cord is formed from the fusion of the posterior divisions of the upper, lower, and middle trunks.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 41
Incorrect
-
A 20-year-old woman had profuse watery diarrhoea for 2 days. She felt dizzy and weak, and thus decided to seek medical attention. At the emergency room her BP was 80/60 mmHg with a pulse of 118/min. What is the most appropriate intravenous treatment that should be given?
Your Answer:
Correct Answer: Isotonic saline
Explanation:Normal saline is typically the first fluid used when hypovolemia is severe enough to threaten the adequacy of blood circulation. It is isotonic and has long been believed to be the safest fluid to give quickly in large volumes.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 42
Incorrect
-
Which muscle originates from the common flexor tendon of the forearm?
Your Answer:
Correct Answer: Flexor digitorum superficialis
Explanation:The medial epicondyle of the humerus is the site of origin of this group of muscles of the forearm. It originates from the medial epicondyle of the humerus by a common tendon. Fibres from the deep fascia of the forearm, near the elbow and septa, pass from this fascia between the muscles. These muscles include the pronator teres, palmaris longus, flexor carpi radialis, flexor carpi ulnaris and flexor digitorum superficialis.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 43
Incorrect
-
A 66-year-old man complains of constant headaches. On physical examination, the only relevant sign is a dark brown mole located on left his arm which has grown in size over the years and is itchy and painful. A MRI of the brain revealed a solitary lesion at the grey-white junction in the right frontal lobe, without ring enhancement. This lesion is most likely to be:
Your Answer:
Correct Answer: Metastatic carcinoma
Explanation:The location of the mass at the grey–white junction is typical of a metastasis. The most frequent types of metastatic brain tumours originate in the lung, skin, kidney, breast and colon. These tumour cells reach the brain via the bloodstream. This patient is likely to have skin cancer, which caused the metastatic brain tumour.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 44
Incorrect
-
A teenager presents with pain and swelling in a limb which increases after activity. X-rays reveal an expansible, eccentric, lytic lesion in the metaphysis distally in the affected bone surrounded by new bone. What is the most likely diagnosis?
Your Answer:
Correct Answer: Aneurysmal bone cyst
Explanation:Aneurysmal bone cysts tend to develop in patients younger than 20 years old. They usually occur in the metaphyseal region of long bones, and are cystic lesions composed of numerous blood filled channels that grow slowly. In X-rays, they show up as circumscribed lesions, sometimes surrounded by new bone.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 45
Incorrect
-
Macrolides are a group of antibiotics commonly used to treat respiratory tract and soft-tissue infections. Which of the following antibiotics is a macrolide?
Your Answer:
Correct Answer: Erythromycin
Explanation:Erythromycin is a macrolide antibiotic used in the treatment of several bacterial infections, including respiratory tract infections, skin infections, chlamydia infections, pelvic inflammatory disease, and syphilis. It may also be used during pregnancy to prevent Group B streptococcal infection in the new-born.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 46
Incorrect
-
A 25 year old primi gravida lady was scheduled for a regular antenatal check up. During the vaginal exam of this lady, the registrar discovered a malignant growth on the anterior wall of her vagina. Which of the following structures, adjacent to the vagina, is likely to be involved as well?
Your Answer:
Correct Answer: Fundus of the bladder
Explanation:The fundus of the bladder is related anatomically to the anterior surface of the vagina and the urethra as well. If there was a malignant growth in the anterior surface of the vagina, then most likely the fundus of the bladder would be involved as well aspotentially the urethra.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 47
Incorrect
-
Out of the given options, which of the following is the most likely diagnosis in a 25-year old gentleman presenting with a testicular germ cell tumour?
Your Answer:
Correct Answer: Embryonal carcinoma
Explanation:Embryonal carcinoma is a non-seminomatous germ cell tumour of the testis, accounting for 25% testicular tumours. Other germ cell tumours include seminoma, teratoma and choriocarcinoma. Embryonal carcinomas are known to occur in men aged 25-35 years, and occasionally in teens. They are rarely seen in ovaries of females. It can spread to the vas deferens and also to the aortic lymph nodes. Embryonal carcinomas are known to have elements of fetal origin such as cartilage. Usually, the main tumour is about 2.5cm long, with an extension of 8-9cm along the testicular cord. Contiguous spread to the testicle is seen in less than 1% cases.
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This question is part of the following fields:
- Pathology
- Urology
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Question 48
Incorrect
-
Gram positive bacteria differ from gram negative bacteria due to the presence of which of the following structures?
Your Answer:
Correct Answer: Outer membrane
Explanation:The reason bacteria are either Gram-positive or Gram-negative is due to the structure of their cell envelope (the cell envelope is defined as the cell membrane and cell wall plus an outer membrane, if one is present.) Gram-positive bacteria, for example, retain the crystal violet due to the amount of peptidoglycan in the cell wall. It can be said therefore that the Gram-stain procedure separates bacteria into two broad categories based on structural differences in the cell envelope.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 49
Incorrect
-
The chest X-ray of an 10-year-old boy, that presented with low-grade fever and cough, revealed hilar enlargement and parenchymal consolidation in the middle lobes. These X-ray findings are more typical for which of the following diagnoses?
Your Answer:
Correct Answer: Pulmonary tuberculosis
Explanation:Primary pulmonary tuberculosis is seen in patients exposed to Mycobacterium tuberculosis for the firs time. The main radiographic findings in primary pulmonary tuberculosis include homogeneous parenchymal consolidation typically in the lower and middle lobes, lymphadenopathy, miliary opacities and pleural effusion.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 50
Incorrect
-
From which source does the lingual artery originate?
Your Answer:
Correct Answer: External carotid
Explanation:The lingual artery arises from the external carotid between the superior thyroid artery and facial artery. It can be located easily on the lower surface of the tongue. The terminal branch of the lingual artery is the deep lingual artery. On its course the lingual artery gives off side branches: dorsal lingual branches that supply the dorsum of the tongue till the epiglottis; sublingual artery that supplies the sublingual gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 51
Incorrect
-
A 34-year-old woman has been suffering from headaches, fever, vomiting, and confusion for the last 5 days. A CT scan reveals an oedematous mass with ring enhancement in the left temporal region. It is biopsied, revealing glial cells, necrosis, neutrophils and lymphocytes. What is the most likely diagnosis?
Your Answer:
Correct Answer: Cerebral abscess
Explanation:A cerebral abscess can result from direct extension of cranial infections, penetrating head trauma, haematogenous spread, or for unknown causes. An abscess forms when an area of cerebral inflammation becomes necrotic and encapsulated by glial cells and fibroblasts. Oedema around the abscess can increase the intracranial pressure. Symptoms result from increased intracranial pressure and mass effects. It is most frequent in the third decade of life, and when it occurs in children, it is usually associated with congenital heart disease.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 52
Incorrect
-
Decreased velocity of impulse conduction through the atrioventricular node (AV node) in the heart will lead to:
Your Answer:
Correct Answer: Increased PR interval
Explanation:AV node damage may lead to an increase in the PR interval to as high as 0.25 – 0.40 s (normal = 0.12 – 0.20 s). In the case of severe impairment, there might be a complete failure of passage of impulses leading to complete block. In this case, the atria and ventricles will beat independently of each other.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 53
Incorrect
-
An experiment is carried out to observe engulfment and phagocytosis of microbes. Strep pneumoniae are added to a solution of leukocytes with a substance added to enhance the process of phagocytosis. What is this substance?
Your Answer:
Correct Answer: Complement C3b
Explanation:C3b is cleaved from C3 complement with the help of the enzyme C3- convertase. It binds to the cell surface of the offending substance and opsonizes it. This makes it easy for the phagocytes to detect and eliminate them.
IgM does not act as an opsonin but igG does.
Selectins aid leukocytes to bind to the endothelial surfaces.
C5a is a chemo-attractant and histamine a vasodilator.
NADPH oxidises offending substance after phagocytosis within the macrophage.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 54
Incorrect
-
A 15 month old boy has a history of repeated bacterial pneumonia, failure to thrive and a sputum culture positive for H.influenzea and S.pneumoniae. There is no history of congenital anomalies. He is most likely suffering from?
Your Answer:
Correct Answer: X-linked agammaglobulinemia
Explanation:Recurrent bacterial infections may be due to lack of B-cell function, consequently resulting in a lack of gamma globulins production. Once the maternal antibodies have depleted, the disease manifests with greater severity and is called x-linked agammaglobulinemia also known as ‘X-linked hypogammaglobulinemia’, ‘XLA’ or ‘Bruton-type agammaglobulinemia. it is a rare x linked genetic disorder that compromises the bodies ability to fight infections.
Acute leukaemia causes immunodeficiency but not so specific.
DiGeorge syndrome is due to lack of T cell function.
Aplastic anaemia and EBV infection does not cause immunodeficiency.
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This question is part of the following fields:
- Inflammation & Immunology; Respiratory
- Pathology
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Question 55
Incorrect
-
Which of the following is true about myasthenia gravis?
Your Answer:
Correct Answer: Response of skeletal muscle to nerve stimulation is weakened
Explanation:An autoimmune disorder, myasthenia gravis leads to progressive muscle weakness. It occurs due to formation of antibodies against the nicotinic acetylcholine (ACh) receptor of the motor endplate, which leads to impaired neuromuscular transmission. Thus, nerve stimulation will lead to a weakened muscle response, but direct electrical stimulation will bring about a normal response. Diagnostic test includes improvement of muscle weakness by small doses of acetylcholinesterase inhibitors (physostigmine or edrophonium). However, a large dose of physostigmine worsens the weakness due to desensitisation of the endplate to persistent Ach. One of the investigative tools includes radiolabelled snake venom α-bungarotoxin. It is an in vitro study performed on muscle biopsy specimens and used to quantify the number of ACh receptors at the motor endplate.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 56
Incorrect
-
A 55 year old lady underwent an uneventful appendicectomy. Two hours later, her arterial blood gas analysis on room revealed pH: 7.30, p(CO2): 53 mmHg and p(O2): 79 mmHg. What is the most likely cause of these findings?
Your Answer:
Correct Answer: Alveolar hypoventilation
Explanation:In the given problem, there is respiratory acidosis due to hypercapnia from a low respiratory rate and/or volume (hypoventilation). Causes of hypoventilation include conditions impairing the central nervous system (CNS) respiratory drive, impaired neuromuscular transmission and other causes of muscular weakness (drugs and sedatives), along with obstructive, restrictive and parenchymal pulmonary disorders. Hypoventilation leads to hypoxia and hypercapnia reduces the arterial pH. Severe acidosis leads to pulmonary arteriolar vasoconstriction, systemic vascular dilatation, reduced myocardial contractility, hyperkalaemia, hypotension and cardiac irritability resulting in arrhythmias. Raised carbon dioxide concentration also causes cerebral vasodilatation and raised intracranial pressure. Over time, buffering and renal compensation occurs. However, this might not be seen in acute scenarios where the rise in p(CO2) occurs rapidly.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 57
Incorrect
-
Extracellular body fluid as compared with intracellular body fluid:
Your Answer:
Correct Answer: Is relatively rich in glucose
Explanation:The percentages of body water contained in various fluid compartments add up to total body water (TBW). This water makes up a significant fraction of the human body, both by weight and by volume. Ensuring the right amount of body water is part of fluid balance, an aspect of homeostasis. The extracellular fluid (ECF) includes all fluids outside the cells. This fluid can be divided into three fluid departments: interstitial (in the tissue spaces) fluid, blood plasma and lymph, and specialised compartments called transcellular fluid. The extracellular fluid surrounds all the cells in the body and is in equilibrium with the intracellular fluid. So, its composition must remain fairly constant even though substances are passing into and out of the cells. The interstitial fluid, though called a fluid, is in a reality a gel-like composition made up of: water, proteoglycan molecules and collagen. The extracellular fluid constitutes 40% of total body water, with intracellular fluid making up the remaining 60%. It is relatively rich in glucose.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 58
Incorrect
-
A syndrome responsible for failure to absorb vitamin B12 from the GIT is called?
Your Answer:
Correct Answer: Pernicious anaemia
Explanation:Pernicious anaemia is a type of autoimmune disease in which antibodies form against the parietal cells or intrinsic factor. Intrinsic factor is required for the absorption of vitamin B12. Blood testing typically shows a macrocytic, normochromic anaemia and low levels of serum vitamin B12. A Schilling test can then be used to distinguish between pernicious anaemia, vitamin B12 malabsorption and vitamin B12 deficiency. Symptoms include shortness of breath, pallor and diarrhoea etc.
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This question is part of the following fields:
- General
- Physiology
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Question 59
Incorrect
-
Which of the following structures, is the area in which the superior cerebral veins drain into?
Your Answer:
Correct Answer: Superior sagittal sinus
Explanation:The superior cerebral veins are predominantly located on the superior aspect of the brain. They are 8 to 12 in number and they drain the lateral, medial and superior aspects of the cerebral hemispheres.
These veins drain into the superior sagittal sinus, also known as the superior longitudinal sinus – which is located along the attached margin of the falx cerebri.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 60
Incorrect
-
Injury to this nerve will result to the loss of general sensory innervation of the lacrimal gland:
Your Answer:
Correct Answer: Ophthalmic nerve
Explanation:The lacrimal glands are paired, almond-shaped exocrine glands, that secrete the aqueous layer of the tear film. The lacrimal nerve, derived from the ophthalmic nerve, supplies the sensory component of the lacrimal gland. The greater petrosal nerve, derived from the facial nerve, supplies the parasympathetic autonomic component of the lacrimal gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 61
Incorrect
-
A 27-year-old woman has chronic low serum calcium levels. Which of the following conditions may be responsible for the hypocalcaemia in this patient?
Your Answer:
Correct Answer: Hypoparathyroidism
Explanation:Chronic hypocalcaemia is mostly seen in patients with hypoparathyroidism as a result of accidental removal or damage to parathyroid glands during thyroidectomy.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 62
Incorrect
-
Regarding the posterior compartment of the leg, which is correct?
Your Answer:
Correct Answer: The muscles plantarflex the foot and are innervated by the tibial nerve
Explanation:The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris. Deep muscles include tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus. The superficial ( calf muscles) which are responsible for plantarflexion of the foot are supplied by the tibial nerve as follows: the gastrocnemius and soleus muscles are supplied by the first and second sacral nerves and the plantaris by the fourth and fifth lumbar and first sacral nerve (the tibial nerve).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 63
Incorrect
-
A 5-year-old child is rushed to the emergency department because of fever, erythema and neck stiffness. The child is also hypotensive upon physical examination. Which is the most likely toxin responsible for this child's condition?
Your Answer:
Correct Answer: Endotoxin
Explanation:An endotoxin is part of the bacterial outer membrane, and it is not released until the bacterium is killed by the immune system. The body’s response to an endotoxin can involve severe inflammation. In general, the inflammation process is usually considered beneficial to the infected host, but if the reaction is severe enough, it can lead to sepsis.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 64
Incorrect
-
Which best describes the suprascapular nerve?
Your Answer:
Correct Answer: It contains nerve fibres from C5 and C6 spinal cord segments
Explanation:The suprascapular nerve arises from the cervical spinal nerves 5 and 6 after coming together to form common trunk. This nerve supplies the supraspinatus and infraspinatus muscles giving off branches to the shoulder joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 65
Incorrect
-
A 68-year-old woman complains of headaches, dizziness, and memory loss. About a month ago, she fell from a staircase but only suffered mild head trauma. What is the most likely diagnosis in this case?
Your Answer:
Correct Answer: Chronic subdural haematoma
Explanation:A quarter to a half of patients with chronic subdural haematoma have no identifiable history of head trauma. If a patient does have a history of head trauma, it usually is mild. The average time between head trauma and chronic subdural haematoma diagnosis is 4–5 weeks. Symptoms include decreased level of consciousness, balance problems, cognitive dysfunction and memory loss, motor deficit (e.g. hemiparesis), headache or aphasia. Some patients present acutely. They usually result from tears in bridging veins which cross the subdural space, and may cause an increase in intracranial pressure (ICP).
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This question is part of the following fields:
- Neurology
- Pathology
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Question 66
Incorrect
-
A 45 year old female had a stroke and was diagnosed with a homonymous hemianopsia. Which of the following structures was likely affected?
Your Answer:
Correct Answer: Optic radiation
Explanation:Hemianopia or hemianopsia, is the loss of vision of half of the eye or loss of half the visual field. Homonymous hemianopia is the loss of vision or blindness on half of the same side of both eyes (visual field) – either both lefts of the eyes or both rights of the eyes. This condition is mainly caused by cerebrovascular accidents like a stroke that affects the optic radiation.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 67
Incorrect
-
Which of the following tumours has the best prognosis following surgery?
Your Answer:
Correct Answer: Schwannoma
Explanation:Schwannomas are histologically benign neoplasms that arise from nerve sheaths, most commonly from sensory nerve roots. They are generally contained within a capsule, and so can be surgically removed without injuring the associated nerve root. They are histologically benign and less than 1% become malignant.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 68
Incorrect
-
A 35-year-old ultra marathon runner becomes severely dehydrated and collapses. This patient most likely has:
Your Answer:
Correct Answer: Decreased baroreceptor firing rate
Explanation:Baroreceptors are sensors located in the blood vessels of all vertebrate animals. They sense the blood pressure and relay the information to the brain, so that a proper blood pressure can be maintained. Acute dehydration results in decreased plasma volume and increased plasma osmolarity, since more water than salt is lost in sweat. The decrease in plasma volume leads to an inhibition of the baroreceptors and a lower firing rate. The increase in plasma osmolarity leads to increased ADH secretion and high plasma ADH levels, which increases water permeability of collecting duct cells. Therefore more water is reabsorbed by the kidneys and renal water excretion is low.
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This question is part of the following fields:
- Physiology
- Renal
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Question 69
Incorrect
-
Pseudomonas aeruginosa is a multidrug resistant pathogen that causes hospital-acquired infections. It is usually treated with piperacillin or another antibiotic. Which of the following is the other antibiotic?
Your Answer:
Correct Answer: Azlocillin
Explanation:Azlocillin, like piperacillin, is an acylampicillin antibiotic with an extended spectrum of activity and greater in vitro potency than the carboxypenicillins. Azlocillin is similar to mezlocillin and piperacillin. It demonstrates antibacterial activity against a broad spectrum of bacteria, including Pseudomonas aeruginosa.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 70
Incorrect
-
A young man was thrown from a vehicle in a collision. He landed on his head and shoulder tip, stretching the left side of his neck. A neurological examination revealed that the fifth and sixth cervical nerves had been torn from the spinal cord. What is the most obvious clinical manifestation of this?
Your Answer:
Correct Answer: Abduction
Explanation:In the case of injuries to the upper roots of the brachial plexus there is complete loss of abduction. The muscle performing this movement is the supraspinatus. This initiates the movement, followed by the deltoid muscle, which allows for complete abduction. Both these muscles are innervated by nerves originating from C5 and C6. The injury to these roots results in a condition named Erb-Duchenne’s palsy.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 71
Incorrect
-
A 58-year-old woman presents with signs of inflammation in the first metatarsophalangeal joint: redness, swelling and pain. The analysis of synovial fluid reveals needle-shaped, strongly negatively birefringent crystals. What's the most likely diagnosis in this case?
Your Answer:
Correct Answer: Gout
Explanation:Gout is a rheumatic disease caused by the precipitation of monosodium urate crystals into tissues, usually joints. This causes acute or chronic pain; the acute illness initially affects only one joint, often the first metatarsophalangeal joint. The diagnosis of the disease requires the identification of crystal in the synovial fluid. These crystals are needle-shaped and strongly negatively birefringent.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 72
Incorrect
-
A 25-year-old football player suffers severe head trauma during a game. Physical examination reveals a decerebrate posture and bilateral papilledema. A CT scan reveals marked diffuse cerebral oedema. This condition will be most severe in which component of the brain?
Your Answer:
Correct Answer: White matter
Explanation:The greatest amount of salt and water increase with cerebral oedema occurs within the white matter. Any swelling from oedema, haemorrhage or haematoma increases the intracranial pressure (ICP). As the ICP increases, the cerebral perfusion decreases and brain tissue can become ischaemic, even leading to brain death.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 73
Incorrect
-
A 35 year old patient presenting with haematemesis, heart burn and bloody stool was diagnosed with a duodenal ulcer that had eroded the gastroduodenal artery. The patient was then rushed into theatre for an emergency procedure to control the haemorrhage. If the surgeon decided to ligate the gastroduodenal artery at its origin, which of the following arteries would most likely experience retrograde blood flow from collateral sources as a result of the ligation?
Your Answer:
Correct Answer: Right gastroepiploic
Explanation:In the stomach and around the duodenum, there are many arterial anastomoses. Ligation of the gastroduodenal artery would result in the retrograde flow of blood from the left gastroepiploic artery to the right gastroepiploic artery. The blood flows into the right gastroepiploic artery, a branch of the gastroduodenal artery from the left gastroepiploic artery that branches from the splenic artery. This retrograde blood flow is aimed at providing alternate blood flow to the greater curvature of the stomach.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 74
Incorrect
-
An 18 year-old with an iron deficient diet was prescribed an iron supplement by her GP. Lack of iron often results in:
Your Answer:
Correct Answer: Hypochromic anaemia
Explanation:Iron deficiency anaemia is the most common type of anaemia. It can occur due to deficiency of iron from decreased intake, increased loss or inadequate absorption. An MCV less than 80 will indicated iron deficiency anaemia. On the smear the RBCs will be microcytic hypochromic and will also show poikilocytosis. Iron profile tests are important to make a diagnosis. Clinically the patient will be pale and lethargic.
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This question is part of the following fields:
- General
- Physiology
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Question 75
Incorrect
-
After a prolonged coronary artery bypass surgery, a 60-year old gentleman was transfused 3 units of fresh-frozen plasma and 2 units of packed red cells. Two days later, the nurse noticed that he was tachypnoeic and chest X-ray showed signs consistent with adult respiratory distress syndrome. Which of the following variables will be low in this patient?
Your Answer:
Correct Answer: Compliance of the lung
Explanation:Acute or adult respiratory distress syndrome (ARDS) is a reaction to several forms of lung injuries and is commonly associated with sepsis and SIRS (systemic inflammatory response syndrome), severe traumatic injury, severe head injury, narcotics overdose, drowning, pulmonary contusion, and multiple blood transfusions. There is an increase in risk due to pre-existing liver disease or coagulation abnormalities. It results due to indirect toxic effects of neutrophil-derived inflammatory mediators in the lungs. ARDS is defined by the 1994 American–European Consensus Committee as the acute onset of bilateral infiltrates on chest X-ray, a partial pressure of arterial oxygen (pa(O2)) to fraction of inspired oxygen Fi(O2) ratio of less than 200 mmHg and a pulmonary artery occlusion pressure of less than 18 or the absence of clinical evidence of left arterial hypertension. ARDS is basically pulmonary oedema in the absence of volume overload or poor left ventricular function. This is different from acute lung injury, which shows a pa(O2)/Fi(O2) ratio of less than 300 mmHg. Pathogenesis of ARDS starts from damage to alveolar epithelium and vascular endothelium, causing increased permeability. Damage to surfactant-producing type II cells disrupts the production and function of pulmonary surfactant, causing micro atelectasis and poor gas exchange. There is a decrease in lung compliance and increase in work of breathing. Eventually, there is resorption of alveolar oedema, regeneration of epithelial cells, proliferation and differentiation of type II alveolar cells and alveolar remodelling. Some show resolution and some progress to fibrosing alveolitis, which involves the deposition of collagen in alveolar, vascular and interstitial spaces.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 76
Incorrect
-
In relation to the muscles of facial expression, It is true to say:
Your Answer:
Correct Answer: They are in the same subcutaneous plane as the platysma muscle
Explanation:The facial muscles generally originate from the facial bones and attach to the skin, in the same plane as the platysma muscle. They are all innervated by cranial nerve VII (the facial nerve). The occipitofrontalis muscle consists of two parts: The occipital belly, near the occipital bone, and the frontal belly, near the frontal bone.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 77
Incorrect
-
The parasympathetic fibres of the oculomotor nerve was impinged due to a growing tumour. The function of which of the following structures will be affected?
Your Answer:
Correct Answer: Ciliary muscle
Explanation:The oculomotor nerve is the third cranial nerve (CNIII). It offers motor and parasympathetic innervation to many of the ocular structures. The motor fibres innervate a number of the extraocular muscles. While the parasympathetic fibres supply the sphincter pupillae and the ciliary muscles of the eye, and the sympathetic fibres innervates the superior tarsal muscles.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 78
Incorrect
-
Which one of the following is a derivative of the midgut?
Your Answer:
Correct Answer: Caecum
Explanation:The primary intestinal loop is formed from the midgut which gives rise to the distal half of the duodenum, the jejunum, ascending colon, proximal two thirds of the transverse colon and the ileum.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 79
Incorrect
-
Which of the following mediators of inflammation requires arachidonic acid for synthesis?
Your Answer:
Correct Answer: Prostaglandins
Explanation:Arachidonic acid is normally present in the phospholipids that make up the cell membrane and is cleaved by phospholipase A2 from the phospholipid. Arachidonic acid is a precursor for the production of eicosanoids which include: 1) prostaglandins, prostacyclins and thromboxane, 2) leukotrienes and 3) anandamides. The production of these products along with their action on the body is called the arachidonic acid cascade.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 80
Incorrect
-
To reach the oral vestibule, the parotid duct must pierce this muscle:
Your Answer:
Correct Answer: Buccinator muscle
Explanation:The parotid duct or Stensen duct is a duct and the route that saliva takes from the major salivary gland, the parotid gland into the mouth. The parotid duct is formed when several interlobular ducts—the largest ducts inside the parotid gland join. It emerges from the gland and runs forward along the lateral side of the masseter muscle. In this course, the duct is surrounded by the buccal fat pad. It takes a steep turn at the border of the masseter and passes through the buccinator muscle, opening into the vestibule of the mouth, between the cheek and the gums, at the parotid papilla, which lies across the second superior molar tooth.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 81
Incorrect
-
When inserting a chest drain anteriorly into the second intercostal space, one must identify the second costal cartilage by palpating which landmark?
Your Answer:
Correct Answer: Sternal angle
Explanation:The sternal angle is the site for identification of the second rib as the second rib is attached to the sternum at this point.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 82
Incorrect
-
Dysarthria, nystagmus and a tremor worsening with directed movement are likely to be seen in:
Your Answer:
Correct Answer: Cerebellar disease
Explanation:The given symptoms are seen in diseases affecting the cerebellum. A cerebellar tremor is a slow tremor that occurs at the end of a purposeful movement. It is seen in cerebellar disease, such as multiple sclerosis or some inherited degenerative disorders and chronic alcoholism. Classically, tremors are produced in the same side of the body as a one-sided lesion. Cerebellar disease can also result in a wing-beating’ type of tremor called rubral or Holmes’ tremor – a combination of rest, action and postural tremors. Other signs of cerebellar disease include dysarthria (speech problems), nystagmus (rapid, involuntary rolling of the eyes), gait problems and postural tremor of the trunk and neck.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 83
Incorrect
-
Which of the following statements regarding the arteries in the neck are TRUE?
Your Answer:
Correct Answer: The thyrocervical trunk typically gives rise to the inferior thyroid artery, transverse cervical artery and suprascapular artery
Explanation:The thyrocervical trunk is one of the three branches of the first part of the subclavian artery and gives numerous branches which supply viscera of the neck, the brachial plexus, neck muscles and scapular anastomoses. The vertebral arteries are major arteries of the neck. They arise as branches from the subclavian arteries and merge to form the single midline basilar artery. The carotid sinus is a dilated area at the base of the internal carotid artery just superior to the bifurcation of the internal carotid and external carotid at the level of the superior border of thyroid cartilage.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 84
Incorrect
-
A elderly patient with bulbar palsy is bed ridden. While swallowing he aspirates one of his tablets into his lungs. In which bronchopulmonary segments is it most likely to end up?
Your Answer:
Correct Answer: Superior segmental bronchus of the right inferior lobe
Explanation:Inhaled objects are more likely to enter the right lung for several reasons. First the right bronchus is shorter, wider and more vertical than the left bronchus. Also, the carina (a ridge-like structure at the point of tracheal bifurcation) is set a little towards the left. The superior segmental bronchus branches posteriorly off the intermediate bronchus or the inferior lobe bronchus and is thus more likely to receive the foreign body that enters the right main bronchus. The lingula is only found on the left lung. The terminal bronchiole is a very small space almost impossible for the tablet to lodge here.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 85
Incorrect
-
Which of these HLA alleles is most likely to be present in ankylosing spondylitis?
Your Answer:
Correct Answer: HLA-B27
Explanation:Ankylosing spondylitis usually appears between the ages of 20-40 years old and is more frequent in men. It is strongly associated with HLA-B27, along with other spondyloarthropathies, which can be remembered through the mnemonic PAIR (Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, and Reactive arthritis).
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 86
Incorrect
-
Which of the following is not seen as a complication of wound healing?
Your Answer:
Correct Answer: Malignancy
Explanation:Complications in wound healing can originate due to abnormalities in the repair process. These abnormalities are :
1) Deficient scar formation: insufficient granulation tissue can lead to wound dehiscence and ulceration. Dehiscence or wound rupture is seen most commonly in abdominal surgery due to increased intraabdominal pressure. Ulcerations are common in extremity wounds due to inadequate vascularization.
2) Excessive formation of repair components: collagen being laid down may begin normally however later lead to a raised scar also called a hypertrophic scar, which can extend beyond its boundaries to form a keloid and
3) Formation of contractures.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 87
Incorrect
-
A young man came to the emergency room after an accident. The anterior surface of his wrist was lacerated with loss of sensation over the thumb side of his palm. Which nerves have been damaged?
Your Answer:
Correct Answer: Median
Explanation:The median nerve provides cutaneous innervation to the skin of the palmar radial three and a half fingers. Also the site of injury indicates that the medial nerve may have been injured as it passes into the hand by crossing over the anterior wrist.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 88
Incorrect
-
Which of the following clinical signs will be demonstrated in a case of Brown-Séquard syndrome due to hemisection of the spinal cord at mid-thoracic level?
Your Answer:
Correct Answer: Ipsilateral spastic paralysis, ipsilateral loss of vibration and proprioception (position sense) and contralateral loss of pain and temperature sensation beginning one or two segments below the lesion
Explanation:Brown–Séquard syndrome results due to lateral hemisection of the spinal cord and results in a loss of motricity (paralysis and ataxia) and sensation. The hemisection of the cord results in a lesion of each of the three main neural systems: the principal upper motor neurone pathway of the corticospinal tract, one or both dorsal columns and the spinothalamic tract. As a result of the injury to these three main brain pathways the patient will present with three lesions. The corticospinal lesion produces spastic paralysis on the same side of the body (the loss of moderation by the upper motor neurons). The lesion to fasciculus gracilis or fasciculus cuneatus results in ipsilateral loss of vibration and proprioception (position sense). The loss of the spinothalamic tract leads to pain and temperature sensation being lost from the contralateral side beginning one or two segments below the lesion. At the lesion site, all sensory modalities are lost on the same side, and an ipsilateral flaccid paralysis.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 89
Incorrect
-
A patient sustained an injury to the facial nerve after it emerges from the stylomastoid foramen. What is the clinical impact of this injury?
Your Answer:
Correct Answer: Facial expression
Explanation:The facial nerve is the seventh of the twelve paired cranial nerves. It emerges from the brainstem between the pons and the medulla. It controls the muscles of facial expression and supplies taste fibres to the anterior two-thirds of the tongue. It also supplies preganglionic parasympathetic fibres to several head and neck ganglia. Its branches and distribution are as follows:
Inside the facial canal (proximal to the stylomastoid foramen):
– Greater petrosal nerve – provides parasympathetic innervation to the lacrimal gland, as well as special taste sensory fibres to the palate via the nerve of pterygoid canal
– Nerve to stapedius – provides motor innervation for the stapedius muscle in the middle ear
– Chord tympani – provides parasympathetic innervation to the submandibular and sublingual glands and special sensory taste fibres for the anterior two-thirds of the tongue
Outside the skull (distal to the stylomastoid foramen):
– Posterior auricular nerve – controls the movements of some of the scalp muscles around the ear
– Five major facial branches (in the parotid gland), from top to bottom: temporal branch, zygomatic branch, buccal branch, marginal mandibular branch and cervical branch. From the description given above it is obvious that injury to the facial nerve distal to the stylomastoid foramen will affect facial expression.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 90
Incorrect
-
A 25 year old man presented with a history of headache and peripheral cyanosis. He had been living in the Himalayas for 6 months prior to this. What is the reason for his condition?
Your Answer:
Correct Answer: Physiological polycythaemia
Explanation:Polycythaemia is a condition that results in an increase in the total number of red blood cells (RBCs) in the blood. It can be due to myeloproliferative syndrome or due to chronically low oxygen levels or rarely malignancy. In primary polycythaemia/polycythaemia vera the increase is due to an abnormality in the bone marrow, resulting in increases RBCs, white blood cells (WBCs) and platelets. In secondary polycythaemia the increase occurs due to high levels of erythropoietin either artificially or naturally. The increase is about 6-8 million/cm3 of blood. A type of secondary polycythaemia is physiological polycythaemia where people living in high altitudes who are exposed to hypoxic conditions produce more erythropoietin as a compensatory mechanism for thin oxygen and low oxygen partial pressure.
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This question is part of the following fields:
- General
- Physiology
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Question 91
Incorrect
-
Question 92
Incorrect
-
Which of the following is the most likely cause of prolonged thrombin clotting time?
Your Answer:
Correct Answer: Hypofibrinogenemia
Explanation:Thrombin clotting time, also called thrombin time (TT), is test used for the investigation of possible bleeding or clotting disorders. TT reflects the conversion of fibrinogen to fibrin and it’s also very sensitive to the presence of the anticoagulant heparin. A prolonged thrombin time may indicate the presence of hypofibrinogenemia (decreased fibrinogen level ), dysfibrinogenaemia, disseminated intravascular coagulation (DIC), end stage liver disease or malnutrition.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 93
Incorrect
-
Which of the following proteins prevents red blood cells (RBCs) from bursting when they pass through capillaries?
Your Answer:
Correct Answer: Spectrin
Explanation:Spectrin is a structural protein found in the cytoskeleton that lines the intercellular side of the membrane of cells which include RBCs. They maintain the integrity and structure of the cell. It is arranged into a hexagonal arrangement formed from tetramers of spectrin and associated with short actin filaments that form junctions allowing the RBC to distort its shape.
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This question is part of the following fields:
- General
- Physiology
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Question 94
Incorrect
-
A 60-year-old female has sudden onset of high-grade fever associated with cough with productive rusty-coloured sputum. Chest x-ray showed left-sided consolidation. What is the most accurate test for the diagnosis of this patient?
Your Answer:
Correct Answer: Sputum culture
Explanation:Sputum culture is used to detect and identify the organism that are infecting the lungs or breathing passages.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 95
Incorrect
-
Which nerve mediates the sensation to itch from the skin that is just over the base of the spine of your scapula?
Your Answer:
Correct Answer: Dorsal primary ramus of C7
Explanation:The first branches off spinal nerves are called the dorsal and ventral rami. The dorsal rami mediate sensation of the skin over the back and motor supply to the true muscles of the back whilst the ventral rami gives sensation to the skin over the limbs and the skin that is over the ventral side of the trunk. It also gives motor supply to the skeletal muscles of the neck, the trunk and extremities. Hence, itchiness of the part of the skin that is over the spine of the scapula would be mediated by the primary ramus of C7. Accessory nerve doesn’t have any sensory innervation.
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This question is part of the following fields:
- Anatomy
- Neurology
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Question 96
Incorrect
-
A 40-year old Caucasian male came to the hospital with complaints of fatigue and lethargy. On examination, he was found to have raised blood pressure. Urine examination showed >300 mg/dl proteinuria (4+) and 24-hour urine protein 3.5g. No glucose, blood, nitrites, urobilinogen or casts were present in urine. What is the most likely diagnosis?
Your Answer:
Correct Answer: Membranous glomerulonephritis
Explanation:Membranous glomerulonephritis or nephropathy, is a renal disorder with insidious course and usually affects people aged 30-50 years. 85% cases are primary (or idiopathic). The other 15% are secondary to autoimmune conditions like SLE, infections like malaria or hepatitis B, drugs like captopril and NSAIDs, or malignancies (particularly lung or colonic carcinoma). This disease is caused due to circulating immune complexes which are said to form by binding of antibodies to antigens in glomerular basement membrane. This antigens could be endogenous or derived from systemic circulation. This immune complex triggers the complement system, resulting in formation of membrane attack complex (MAC) on glomerular epithelial cells. This further results in release of proteases and oxidants which damage the capillaries making them ‘leaky’. Moreover, the epithelial cells also secrete a mediator to reduce nephron synthesis and distribution.
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This question is part of the following fields:
- Pathology
- Renal
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Question 97
Incorrect
-
Whilst snorkelling, a 30-year old gentleman has the respiratory rate of 10/min, tidal volume of 550 ml and an effective anatomical dead space of 250 ml. What is his alveolar ventilation?
Your Answer:
Correct Answer: 3000 ml/min
Explanation:Alveolar ventilation is the amount of air reaching the alveoli per minute. Alveolar ventilation = respiratory rate × (tidal volume – anatomical dead space volume). Thus, alveolar ventilation = 10 × (550 − 250) = 3000 ml/min.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 98
Incorrect
-
Which organs would cause pain in a patient who complains of dull pain in her pelvis, along the midline starting from the pubic bone in the front to the sacrum at the back?
Your Answer:
Correct Answer: Urinary bladder, uterus/cervix/vagina, rectum
Explanation:The pain could have been caused by the urinary bladder, uterus/cervix/vagina or rectum as it involves the pelvic viscera.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 99
Incorrect
-
A 50 year old man on warfarin therapy following insertion of a pacemaker presented with epistaxis. Which of the following is true regarding blood coagulation?
Your Answer:
Correct Answer: Patients with haemophilia A usually have a normal bleeding time
Explanation:A prolonged bleeding time is seen in platelet disorders like thrombocytopenia. Patients with haemophilia A or B have a prolonged PTT but not a prolonged bleeding time.
Ca2+ is necessary for coagulation.
von Willebrand factor is an important part of the factor VIII complex and promotes platelet adhesion and aggregation.
DIC results in depleted coagulation factors and accumulation of fibrin.
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This question is part of the following fields:
- General
- Physiology
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Question 100
Incorrect
-
Calculate the cardiac stroke volume of a patient whose oxygen consumption (measured by analysis of mixed expired gas) is 300 ml/min, arterial O2 content is 20 ml/100 ml blood, pulmonary arterial O2 content is 15 ml/100 ml blood and heart rate is 60/min.
Your Answer:
Correct Answer: 100 ml
Explanation:By Fick’s principle, VO2 = Q × (CA (O2) − CV (O2)) where VO2 = O2 consumption, Q = cardiac output and CA(O2) and CV(O2) are arterial and mixed venous O2 content respectively. Thus, in the given problem, 300 ml O2/min = Q × (20−15) ml O2/100 ml. Thus, Q = 6000 ml blood/min. Then, we can calculate stroke volume by dividing the cardiac output with heart rate. Thus, stroke volume = 6000 ml/min divided by 60/min stroke volume = 100 ml.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 101
Incorrect
-
Vincristine is a chemotherapy agent used to treat a number of types of cancer. Which of the following is a recognised major side-effect of vincristine?
Your Answer:
Correct Answer: Peripheral neuropathy
Explanation:Vincristine is an alkaloid chemotherapeutic agent. It is used to treat a number of types of cancer including acute lymphocytic leukaemia, acute myeloid leukaemia, Hodgkin’s disease, neuroblastoma, and small cell lung cancer among others. The main side-effects of vincristine are peripheral neuropathy and constipation.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 102
Incorrect
-
A 40-year old gentleman underwent a computed tomographic scan for the abdomen to rule out blunt abdominal trauma, after a vehicular accident. The scan revealed no abnormal finding except for a 1 cm-sized cortical mass in the left adrenal gland. The doctor-on-call decided to not intervene for this mass because it was likely to be a:
Your Answer:
Correct Answer: Non-functioning adrenal adenoma
Explanation:Adrenal adenomas are common, benign lesions which are asymptomatic and seen in 10% of population. Usually detected incidentally on Computed tomography (‘incidentaloma’), only around 1 in 10,000 are malignant (adenocarcinoma). Adrenal adenomas rarely need to be investigated, especially if they are homogenous and less than 3 cm in diameter. Follow-up imaging can be done after an interval of 3-6 months to assess any change in size. Some adenomas can secrete cortisol (leading to Cushing syndrome), or aldosterone (leads to Conn syndrome) or androgens (leading to hyperandrogenism).
Haematomas and simple cysts are not usually seen in adrenal gland. Infection due to Histoplasma capsulatum is usually bilateral and leads to multiple granulomas. Adrenal metastasis will usually demonstrate a lung primary and the adrenal lesions will be often multiple and larger than 1 cm.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 103
Incorrect
-
Regarding the long head of the biceps femoris, which of the following is correct?
Your Answer:
Correct Answer: It crosses two joints
Explanation:The long head of the biceps femoris arises from the lower and inner impression on the back of the tuberosity of the ischium. It inserts with the short head in an aponeurosis which becomes a tendon and this tendon is inserted into the lateral side of the head of the fibula and the lateral condyle of the tibia, thus crossing two joints.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 104
Incorrect
-
Which of the following will increase blood pressure and cause hypokalaemia?
Your Answer:
Correct Answer: Angiotensin II
Explanation:Angiotensin is a peptide that is released in response to a decrease in blood volume and blood pressure. It has multiple functions but mainly acts to cause vasoconstriction, increase BP and release aldosterone from the adrenal cortex. It is a powerful vasoconstrictor and release of aldosterone causes increased retention of sodium and excretion of potassium.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 105
Incorrect
-
Which muscle is most likely to be affected following an injury to the thoracodorsal nerve (C6-C8)?
Your Answer:
Correct Answer: Latissimus dorsi
Explanation:Latissimus dorsi is a triangular, flat muscle that covers the lumbar region and the lower half of the thoracic region. It is supplied by the sixth, seventh and eighth cervical nerves through the thoracodorsal (long subscapular) nerve.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 106
Incorrect
-
What are some of the derivatives of the second pharyngeal arch?
Your Answer:
Correct Answer: Stylohyoid muscle
Explanation:Also known as the hyoid arch, it forms the side and front of the neck. From its cartilage develops the styloid process, stylohyoid ligament and lesser cornu of the hyoid bone. The muscular derivatives include the muscles of facial expression, stapedius, stylohyoid and the posterior belly of the digastric. All these are innervated by cranial nerve VII but migrate into the area of the mandibular arch.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 107
Incorrect
-
A 5-year-old child presents with fever and otalgia. Greenish pustular discharge was seen in his left ear during physical examination. The patient is diagnosed with otitis externa. Which of the following organisms most likely caused the infection?
Your Answer:
Correct Answer: Pseudomonas aeruginosa
Explanation:P. aeruginosa is a multidrug resistant pathogen recognised for its ubiquity, its advanced antibiotic resistance mechanisms and its association with serious illnesses – especially hospital-acquired infections such as ventilator-associated pneumonia and various septic syndromes. The species name aeruginosa is a Latin word meaning verdigris (copper rust), referring to the blue-green colour of laboratory cultures of the species. This blue-green pigment is a combination of two metabolites of P. aeruginosa, pyocyanin (blue) and pyoverdine (green), which impart the blue-green characteristic colour of cultures.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 108
Incorrect
-
Which of the following is the most likely cause of massive splenomegaly in a 35-year old gentleman?
Your Answer:
Correct Answer: Myelofibrosis
Explanation:Causes of massive splenomegaly include chronic myelogenous leukaemia, chronic lymphocytic leukaemia, lymphoma, hairy cell leukaemia, myelofibrosis, polycythaemia vera, sarcoidosis, Gaucher’s disease and malaria.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 109
Incorrect
-
Lateral medullary syndrome, also known as Wallenberg's syndrome is a neurological condition caused by ischaemia in the lateral part of the medulla oblongata and is commonly associated with numerous neurological symptoms. Which of the following arteries when occluded leads to this condition?
Your Answer:
Correct Answer: Posterior inferior cerebellar
Explanation:The lateral medullary syndrome or Wallenberg’s disease is also known as posterior inferior cerebellar artery syndrome (PICA). This syndrome is a clinical manifestation of the occlusion of the posterior cerebellar artery that results in symptoms of infarction of the lateral medullary oblongata. Other arteries that contribute to blood flow in to this region such are the vertebral artery, superior middle cerebellar and inferior medullary arteries can also result to this syndrome when occluded.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 110
Incorrect
-
Which of the following diseases affects young adults, causing pain in any bone -particularly long bones- which worsens at night, and is typically relieved by common analgesics, such as aspirin?
Your Answer:
Correct Answer: Osteoid osteoma
Explanation:Osteoid osteoma, which tends to affect young adults, can occur in any bone but is most common in long bones. It can cause pain (usually worse at night) that is typically relieved by mild analgesics, such as non-steroidal anti-inflammatory drugs. X-ray findings include a small radiolucent zone surrounded by a larger sclerotic zone.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 111
Incorrect
-
Injury to this nerve will affect the function of the palatoglossus and levator veli palatini muscles:
Your Answer:
Correct Answer: Cranial nerve X
Explanation:The vagus nerve (cranial nerve X) innervates both the palatoglossus and levator veli palatini muscles.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 112
Incorrect
-
The following branch of the aorta is unpaired:
Your Answer:
Correct Answer: Coeliac artery
Explanation:Branches that stem from the abdominal aorta can be divided into three: the visceral branches, parietal branches and terminal branches. Of the visceral branches, the suprarenal, renal, testicular and ovarian arteries are paired while the coeliac artery and superior and inferior mesenteric arteries are unpaired. Of the parietal branches the inferior phrenic and lumbar arteries are paired while the middle sacral artery is unpaired. The terminal branches i.e. the common iliac arteries are paired.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 113
Incorrect
-
Which of these is secreted by both macrophages and muscle cells?
Your Answer:
Correct Answer: Interleukin-6
Explanation:IL-6 is secreted by the T cells and macrophages and is a pro inflammatory cytokine. It is secreted in response to trauma e.g. burns and tissue damage that leads to inflammation. Apart from this its is also a myokine and is elevated due to muscle contraction. Other functions include: stimulate osteoclast formation when secreted by osteoblasts, mediate fever in acute phase response and are responsible for energy metabolism in muscle and fatty tissues. Inhibitors of IL-6 e.g. oestrogen are used as a treatment for postmenopausal osteoporosis.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 114
Incorrect
-
Which tumour occurs in young adults, affecting the epiphyses of the bones and sometimes extending to the soft tissues?
Your Answer:
Correct Answer: Benign giant-cell tumour
Explanation:Benign giant-cell tumours tend to affect adults in their twenties and thirties, occur in the epiphyses and can erode the bone and extend into the soft tissues. These tumours have a strong tendency to recur.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 115
Incorrect
-
Which of the following has the highest content of triglycerides?
Your Answer:
Correct Answer: Chylomicron
Explanation:Created by the small intestinal cells, chylomicrons are large lipoprotein molecules which transport lipids to the liver, adipose, cardiac and skeletal tissue. Chylomicrons are mainly composed of triglycerides (,85%) along with some cholesterol and cholesteryl esters. Apo B-48 is the main apolipoprotein content.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 116
Incorrect
-
A 59-year old gentleman admitted for elective cholecystectomy was found to have a haemoglobin 12.5 g/dl, haematocrit 37%, mean corpuscular volume 90 fl, platelet count 185 × 109/l, and white blood cell count 32 × 109/l; along with multiple, small mature lymphocytes on peripheral smear. The likely diagnosis is:
Your Answer:
Correct Answer: Chronic lymphocytic leukaemia
Explanation:CLL or chronic lymphocytic leukaemia is the most common leukaemia seen in the Western world. Twice more common in men than women, the incidence of CLL increases with age. About 75% cases are seen in patients aged more than 60 years. The blood, marrow, spleen and lymph nodes all undergo infiltration, eventually leading to haematopoiesis (anaemia, neutropenia, thrombocytopenia), hepatomegaly, splenomegaly and decreased production of immunoglobulin. In 98% cases, CD+5 B cells undergo malignant transformation.
Often diagnosed on blood tests while being evaluated for lymphadenopathy, CLL causes symptoms like fatigue, anorexia, weight loss, pallor, dyspnoea on exertion, abdominal fullness or distension. Findings include multiple lymphadenopathy with minimal-to- moderate hepatomegaly and splenomegaly. Increased susceptibility to infections is seen. Herpes Zoster is common. Diffuse or maculopapular skin infiltration can also be seen in T-cell CLL.
Diagnosis is by examination of peripheral blood smear and marrow: hallmark being a sustained, absolute leucocytosis (>5 ×109/l) and increased lymphocytes in the marrow (>30%). Other findings can include hypogammaglobulinemia (<15% of cases) and, rarely, raised lactate dehydrogenase (LDH). Only 10% cases demonstrate moderate anaemia and/or thrombocytopenia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 117
Incorrect
-
Below which level of the spinal cord will the inferior gluteal nerve be unaffected?
Your Answer:
Correct Answer: S3
Explanation:The inferior gluteal nerve arises from the dorsal divisions of the fifth lumbar and first and second sacral nerves. According to this fact any lesion at or below the S3 will not affect the inferior gluteal nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 118
Incorrect
-
Gastric acid secretion is stimulated by which of the following?
Your Answer:
Correct Answer: Gastrin
Explanation:Gastric acid secretion is stimulated by three factors:
– Acetylcholine, from parasympathetic neurones of the vagus nerve that innervate parietal cells directly
– Gastrin, produced by pyloric G-cells
– Histamine, produced by mast cells.
Gastric acid is inhibited by three factors:
– Somatostatin
– Secretin
– Cholecystokinin
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 119
Incorrect
-
If a 70-year-old man with known atrial fibrillation dies suddenly, which of these is the most likely cause of death?
Your Answer:
Correct Answer: Thromboembolism
Explanation:In atrial fibrillation, the abnormal atrial contraction can cause blood to stagnate in the left atrium and form a thrombus, which may then embolize. The patient’s history of AF suggest an embolic disease, which lead to his death.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 120
Incorrect
-
The proximal tubule is the portion of the ductal system of the nephron of the kidney which leads from Bowman's capsule to the loop of Henle. Which of the following is most likely to be seen in a sample of fluid leaving the proximal tubule?
Your Answer:
Correct Answer: It will have no amino acids
Explanation:The proximal tubule is the portion of the duct system of the nephron leading from Bowman’s capsule to the loop of Henlé. The most distinctive characteristic of the proximal tubule is its brush border (or ‘striated border’). The luminal surface of the epithelial cells of this segment of the nephron is covered with densely packed microvilli forming a border which greatly increases the luminal surface area of the cells, presumably facilitating their reabsorptive function. Glucose, amino acids, inorganic phosphate, and some other solutes are100% reabsorbed via secondary active transport through co-transporters driven by the sodium gradient out of the nephron.
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This question is part of the following fields:
- Physiology
- Renal
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Question 121
Incorrect
-
A 76-year-old man with a urinary tract obstruction due to prostatic hyperplasia develops acute renal failure. Which of the following physiological abnormalities of acute renal failure will be most life threatening for this patient?
Your Answer:
Correct Answer: Acidosis
Explanation:Acute renal failure (ARF) is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. This accumulation may be accompanied by metabolic disturbances, such as metabolic acidosis and hyperkalaemia, changes in body fluid balance and effects on many other organ systems. Metabolic acidosis and hyperkalaemia are the two most serious biochemical manifestations of acute renal failure and may require medical treatment with sodium bicarbonate administration and antihyperkalaemic measures. If not appropriately treated these can be life-threatening. ARF is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient amounts of urine.
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This question is part of the following fields:
- Physiology
- Renal
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Question 122
Incorrect
-
The most likely cause of prominent U waves on the electrocardiogram (ECG) of a patient is:
Your Answer:
Correct Answer: Hypokalaemia
Explanation:The U-wave, not always visible in ECGs, is thought to represent repolarisation of papillary muscles or Purkinje fibres. When seen, it is very small and occurs after the T-wave. Inverted U-waves indicate myocardial ischaemia or left ventricular volume overload. Prominent U-waves are most commonly seen in hypokalaemia. Other causes include hypercalcaemia, thyrotoxicosis, digitalis exposure, adrenaline and class 1A and 3 anti-arrhythmic agents. It can also be seen in congenital long-QT syndrome and in intracranial haemorrhage.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 123
Incorrect
-
A brain tumour causing blockage of the hypophyseal portal system is likely to result in an increased secretion of which of the following hormones?
Your Answer:
Correct Answer: Prolactin
Explanation:The hypophyseal portal system links the hypothalamus and the anterior pituitary. With the help of this system, the anterior pituitary receives releasing and inhibitory hormones from the hypothalamus and regulates the action of other endocrine glands. One of the inhibitory hormones carried by this system is the prolactin-inhibitory hormone. In the absence of this hormone which might occur in case of a blockage of the system, prolactin secretion increases to about three times normal levels.
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 124
Incorrect
-
Which of the following is a true statement regarding secretion of gastric acid?
Your Answer:
Correct Answer: Acetylcholine increases gastric acid secretion
Explanation:Gastric acid secretion is increased by acetylcholine, histamine and gastrin, with the help of cAMP as a secondary messenger. They increase H+ and Cl- secretion by increasing the number of H+/K+ ATPase molecules and Cl- channels. In contrast, gastric acid secretion is decreased by somatostatin, epidermal growth factor and prostaglandins.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 125
Incorrect
-
An enlarged lymph node which shows well-defined, prominent paracortical follicles with germinal centres is most likely from which of the following patients?
Your Answer:
Correct Answer: A 5-year-old boy with a sore throat and runny nose
Explanation:Lymphadenopathy is common in children and is usually reactive in nature. The description fits that of a benign, reactive lymph node.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 126
Incorrect
-
A blood sample from a patient with polycythaemia vera will show which of the following abnormalities?
Your Answer:
Correct Answer: High platelet count
Explanation:Polycythaemia is a condition that results in an increase in the total number of red blood cells (RBCs) in the blood. It can be due to a myeloproliferative syndrome, chronically low oxygen levels or rarely malignancy. In primary polycythaemia/ polycythaemia vera the increase is due to an abnormality in the bone marrow, resulting in increased RBCs, white blood cells (WBCs) and platelets. In secondary polycythaemia the increase occurs due to high levels of erythropoietin either artificially or naturally. The increase is about 6-8 million/cm3 of blood. A type of secondary polycythaemia is physiological polycythaemia where people living in high altitudes who are exposed to hypoxic conditions produce more erythropoietin as a compensatory mechanism for thin oxygen and low oxygen partial pressure.
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This question is part of the following fields:
- General
- Physiology
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Question 127
Incorrect
-
A chest x ray is ordered for a 39 year old man who presents with a history of a cough and weight loss for over a month. It shows a rounded opacity in the pleural cavity near the cardiac notch. The opacity is most likely to be in the:
Your Answer:
Correct Answer: Costomediastinal recess
Explanation:The costomediastinal recess is the point where the costal pleura becomes the mediastinal pleura, located right next to the cardiac notch.
The cupola: part of the parietal pleura that extends above the first rib to the root of the lung.
Hilum: located on the medial surface of the lung where neurovascular structures enter and leave the lung.
Pulmonary ligament: pleural fold found below the root of the lung, is a point of continuity between the visceral and mediastinal pleura.
Costodiaphragmatic recess: the lowest extent of the pleural cavity.
Superior mediastinum: part of the mediastinum that contains the great vessels leaving and entering the heart.
The cardiac notch is in the inferior mediastinum.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 128
Incorrect
-
A 13-year-old girl has complained of pain in her left arm for 4 months. An X-ray reveals a mass along with erosion of the affected humerus. Histologically, the tumour is found to be formed by small, round, blue cells. What is the most likely diagnosis?
Your Answer:
Correct Answer: Ewing’s sarcoma
Explanation:Ewing’s sarcoma is formed by small, round, blue cells, and is common in children. The usually develop in limbs, and clinical findings include pain and inflammation, with lytic destruction showing up on X-rays.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 129
Incorrect
-
Which of the following compensatory parameters is responsible for causing an increase in the blood pressure in a 30 year old patient with a BP of 40 mmHg?
Your Answer:
Correct Answer: Baroreceptor reflex
Explanation:The baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for regulating blood pressure. It provides a negative feedback response in which an elevated blood pressure will causes blood pressure to decrease; similarly, decreased blood pressure depresses the baroreflex, causing blood pressure to rise. The system relies on specialised neurones (baroreceptors) in the aortic arch, carotid sinuses and elsewhere to monitor changes in blood pressure and relay them to the brainstem. Subsequent changes in blood pressure are mediated by the autonomic nervous system. Baroreceptors include those in the auricles of the heart and vena cava, but the most sensitive baroreceptors are in the carotid sinuses and aortic arch. The carotid sinus baroreceptors are innervated by the glossopharyngeal nerve (CN IX); the aortic arch baroreceptors are innervated by the vagus nerve (CN X).
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 130
Incorrect
-
Which of the following is the most accurate test for the diagnosis of primary syphilis?
Your Answer:
Correct Answer: Dark-field microscopy
Explanation:Primary syphilis is transmitted via sexual contact. Lesions on genitalia, called a chancre occur after an asymptomatic incubation period of 10-90 days (average 21 days) after exposure. This chancre is a typically solitary (can be multiple), firm, painless, ulceration over the skin at the point of exposure to spirochete, seen on penis, vagina or rectum. It heals spontaneously after 4-6 weeks. Local lymphadenopathy can be seen.
Diagnosis is made by microscopy of fluid from lesion using dark-field illumination, taking care to not confuse with other treponemal disease. Screening tests include rapid plasma regain (RPR) and Venereal Diseases Research Laboratory (VDRL) tests. False positives are known to occur with these tests and can be seen in viral infections like hepatitis, varicella, Epstein-Barr virus, tuberculosis, lymphoma, pregnancy and IV drug use. More specific tests should therefore be carried out in case these screening tests are positive.
The Treponema pallidum hemagglutination assay (TPHA) and the fluorescent treponemal antibody absorption (FTAABS) test are based on monoclonal antibodies and immunofluorescence and are more specific. However, they can too show false positives with other treponemal diseases like yaws or pinta. Other confirmatory tests include those based on enzyme-linked immunoassays.
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This question is part of the following fields:
- Pathology
- Urology
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Question 131
Incorrect
-
A 65-year old gentleman presents to the clinic with chronic back pain and weight loss. His blood count shows a white blood cell count of 10 × 109/l, with a differential count of 66 polymorphonuclear leukocytes, 7 bands, 3 metamyelocytes, 3 myelocytes, 14 lymphocytes, 7 monocytes, and 5 nucleated red blood cells. The haemoglobin is 13 g/dl with a haematocrit of 38.1%, a mean corpuscular volume of 82 fl, and a platelet count of 126 × 109/l. What is the likely diagnosis?
Your Answer:
Correct Answer: Metastatic carcinoma
Explanation:The peripheral blood findings suggest a leucoerythroblastic picture, the common causes of which in a 65-year old gentleman includes prostatic or lung malignancy.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 132
Incorrect
-
An excision of a mass in the right parietal area of the head will be performed. In which layer of the scalp are the nerves and blood vessels located?
Your Answer:
Correct Answer: Connective tissue
Explanation:The scalp is the anatomical area bordered by the face at the front, and by the neck at the sides and back. The scalp is usually described as having five layers:
1. The skin which contains numerous sebaceous glands and hair follicles.
2. The connective tissue, a dense subcutaneous layer of fat and fibrous tissue that lies beneath the skin, containing the nerves and vessels of the scalp.
3. The aponeurosis or galea aponeurotica, a tough layer of dense fibrous tissue which runs from the frontalis muscle anteriorly to the occipitalis posteriorly.
4. The loose areolar connective tissue layer provides an easy plane of separation between the upper three layers and the pericranium.
5. The pericranium is the periosteum of the skull bones and provides nutrition to the bone and the capacity for repair.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 133
Incorrect
-
When you rest your elbows on a desk, what bony landmark of the upper limb are you resting on?
Your Answer:
Correct Answer: Olecranon process of the ulna
Explanation:At the upper and back part of the ulna, there exists a curved eminence which is the olecranon process. This process lodges in the olecranon fossa of the humerus. It’s posterior surface is subcutaneous and this triangular area is what you rest your elbow upon.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 134
Incorrect
-
The absence of which of the following components characterizes the grey platelet syndrome (GPS)?
Your Answer:
Correct Answer: Alpha granules
Explanation:Grey platelet syndrome (GPS) is a rare inherited bleeding disorder associated with an almost total absence of α-granules and their contents. The syndrome is characterised by thrombocytopenia, enlarged platelets that have a grey appearance, myelofibrosis, and splenomegaly. Alpha granules store proteins and growth factors that promote platelet adhesiveness and wound healing. Patients with GPS develop symptoms and signs such as easy bruising, prolonged bleeding, and nose bleeds.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 135
Incorrect
-
A lesion involving the suprachiasmatic nucleus of hypothalamus is likely to affect:
Your Answer:
Correct Answer: Regulation of circadian rhythm
Explanation:The suprachiasmatic nucleus (SCN) in the hypothalamus is responsible for controlling endogenous circadian rhythms and destruction of the SCN leads to a loss of circadian rhythm.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 136
Incorrect
-
A CT scan of 65 year old male patient at an outpatient clinic suggested a bone tumour at the stylomastoid foramen. Which of the following cranial nerves is likely to be affected with this tumour?
Your Answer:
Correct Answer: VII
Explanation:Cranial nerve VII, the facial nerve, is found in the internal acoustic canal and runs through this canal into the facial canal before exiting through the stylomastoid foramen. In the case of a bone tumour at the stylomastoid process, the facial nerve is the nerve that will most likely be affected.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 137
Incorrect
-
A 45-year old male patient with a long history of alcoholism developed liver cirrhosis that has led to portal hypertension. Which of the following plexuses of veins is most likely dilated in this patient?
Your Answer:
Correct Answer: Haemorrhoidal plexus
Explanation:The haemorrhoidal plexus or also known as the rectal plexus is a venous plexus that surrounds the rectum. This venous plexus in males communicates anteriorly with the vesical plexus and uterovaginal plexus in females. This venous plexus forms a site of free communication between the portal and systemic venous systems. In the case of portal hypertension this plexus would most likely dilate due to the increased pressure.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 138
Incorrect
-
Which of these conditions causes haematuria, hypertension and proteinuria in children, usually after a streptococcal infection?
Your Answer:
Correct Answer: Acute nephritic syndrome
Explanation:Nephritic syndrome (or acute nephritic syndrome) is a syndrome comprising of signs of nephritis. Children between 2 and 12 are most commonly affected, but it may occur at any age. Predisposing factors/causes include:
Infections with group A streptococcal bacteria (acute post-streptococcal glomerulonephritis).
Primary renal diseases: immunoglobulin A nephropathy, membranoproliferative glomerulonephritis, idiopathic rapidly progressive crescentic glomerulonephritis.
Secondary renal diseases: subacute bacterial endocarditis, infected ventriculo–peritoneal shunt, glomerulonephritis with visceral abscess, glomerulonephritis with bacterial, viral or parasitic infections.
Multisystem diseases.
By contrast, nephrotic syndrome is characterized by only proteins moving into the urine.
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This question is part of the following fields:
- Physiology
- Renal
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Question 139
Incorrect
-
A 45-year-old woman was brought to the emergency department due to fever and chills. She has a history of recurrent UTI and complains of dysuria and urinary frequency. Urinary white blood cell count is >200 cell/high power field. If urine culture is performed, what is the most likely organism that will grow?
Your Answer:
Correct Answer: Escherichia coli
Explanation:The pathogen that most likely causes recurrent urinary tract infection in young women are E. coli, Enterococcus and Staphylococcus saprophyticus.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 140
Incorrect
-
What is the innervation of the tensor tympani muscle?
Your Answer:
Correct Answer: Trigeminal nerve
Explanation:The tensor veli palatini is innervated by the medial pterygoid nerve, a branch of mandibular nerve, the third branch of the trigeminal nerve (CN V3) – the only muscle of the palate not innervated by the pharyngeal plexus, which is formed by the vagal and glossopharyngeal nerves.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 141
Incorrect
-
A patient who following 20 years of working in the asbestos industry develops malignant mesothelioma and is scheduled for pleuropneumonectomy to remove the entire pleura and lung on the affected side. Which layer would provide a natural cleavage plane for surgical separation of the costal pleura from the thoracic wall?
Your Answer:
Correct Answer: Endothoracic fascia
Explanation:The endothoracic fascia is connective tissue that is between the costal parietal pleura and the inner aspect of the chest wall. Removing this layer of connective tissue would make it easy to separate the costal pleura from the thoracic wall.
Deep fascia: is not found around the lungs. It is a layer of connective tissue that invests a muscle or a group of muscles.
Parietal pleura: part of the pleura that lines the inner surface of the chest/thoracic cavity.
Visceral pleura: is the serous membrane that lines the surface of the lungs.
Transversus thoracis muscle fascia is associated only with the muscle transversus thoracis.
Peritracheal fascia: a layer of connective tissue that invests the trachea. It is not associated with the thoracic wall or the costal pleura.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 142
Incorrect
-
A 60-year old gentleman visited his general practitioner complaining of high grade fever for 7 days and a dull, aching pain in his left lumbar region. On enquiry, he admitted to having a burning sensation while passing urine. His blood results showed an elevated white blood cell count with a left shift. In his condition, which is the most characteristic finding on urine examination?
Your Answer:
Correct Answer: White blood cell casts
Explanation:Tubulointerstitial nephritis is the term given to primary injury to renal tubules and the renal interstitium, which ultimately results in a decline in renal function. Acute tubulointerstitial nephritis (acute pyelonephritis) is often seen as a result of infection or drug reactions. The most characteristic feature of this condition on urine analysis is the presence of white blood cell casts.
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This question is part of the following fields:
- Pathology
- Renal
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Question 143
Incorrect
-
A young boy fell from a tree, sustaining an injury to the elbow area and damaging the nerve behind the medial epicondyle of the humerus. What is the most likely result from that injury?
Your Answer:
Correct Answer: Flexion in the distal interphalangeal joint of digit 5
Explanation:The nerve injured in this situation is the ulnar nerve. It passes posterior to the medial epicondyle of the humerus before going between the two heads of the flexor carpi ulnaris muscle. This nerve supplies the muscles and skin of forearm and hand. At the level of medial epicondyle, the injury will led to paralysis in flexor carpi ulnaris and the ulnar half of the flexor digitorum profundus as well as the palmar interossei and hypothenar muscles in the hand. The correct answer will be that the boy will suffer from inability to flex the distal interphalangeal joint of digit 5
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 144
Incorrect
-
Which of the following associations is correctly matched with the body's defence mechanism in fighting infection?
Your Answer:
Correct Answer: Specific cellular mechanism → cytotoxic T cells
Explanation:The immune system has certain levels of defence against pathogens. First line includes simple barriers such as skin, mucosa and stomach acid that prevent the pathogen from entering into the body. If this barrier is breached then the innate immune system is activated which includes leukocytes (macrophages, neutrophils, mast cells, eosinophils, basophils, natural killer cells). If the pathogens invade the second layer of defence then the third layer, adaptive immunity is activated, which includes B and T lymphocytes. B cells provide a humoral response whereas cytotoxic T cells have specific cellular mechanisms. They maintain a memory of past infections and are activated faster following a recurrence.
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This question is part of the following fields:
- General
- Physiology
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Question 145
Incorrect
-
What is the nerve supply of the muscle that is inserted onto the crest of the lesser tubercle of the humerus?
Your Answer:
Correct Answer: Lower subscapular
Explanation:The muscle is the subscapularis muscle which is supplied by the lower subscapular nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 146
Incorrect
-
A 60-year-old male is suspected to have pancreatic cancer. What particular tumour marker should be requested to aid in the confirmation of the diagnosis of pancreatic cancer?
Your Answer:
Correct Answer: Carcinoembryonic antigen (CEA)
Explanation:Carcinoembryonic antigen (CEA) is used as a tumour marker. CEA test measures the amount of this protein that may appear in the blood of some people who have certain types of cancers especially cancer of the colon and rectal cancer. It may also be present in the pancreas, breast, ovary or lung.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 147
Incorrect
-
A 90-year-old man is prescribed spironolactone after his family notices his legs are swollen. What class of drugs does spironolactone belong to?
Your Answer:
Correct Answer: Potassium-sparing diuretics
Explanation:Spironolactone is a renal competitive aldosterone antagonist in a class of drugs called ‘potassium-sparing diuretics’, that is primarily used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. It is also used in the treatment of high blood pressure, low blood potassium, early-onset puberty, and acne and excessive hair growth in women. Spironolactone inhibits the effect of aldosterone by competing for intracellular aldosterone receptors in the distal tubule cells. This increases the secretion of water and sodium, while decreasing the excretion of potassium.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 148
Incorrect
-
Acute respiratory distress syndrome (ARDS) is a medical condition that occurs in critically ill patients, and can be triggered by events such as trauma and sepsis. Which of the following variables is most likely to be lower than normal in a patient with ARDS?
Your Answer:
Correct Answer: Lung compliance
Explanation:Acute (or Adult) respiratory distress syndrome (ARDS) is a medical condition occurring in critically ill patients characterized by widespread inflammation in the lungs. The development of acute respiratory distress syndrome (ARDS) starts with damage to the alveolar epithelium and vascular endothelium, resulting in increased permeability to plasma and inflammatory cells. These cells pass into the interstitium and alveolar space, resulting in pulmonary oedema. Damage to the surfactant-producing type II cells and the presence of protein-rich fluid in the alveolar space disrupt the production and function of pulmonary surfactant, leading to micro atelectasis and impaired gas exchange. The pathophysiological consequences of lung oedema in ARDS include a decrease in lung volumes, compliance and large intrapulmonary shunts. ARDS may be seen in the setting of pneumonia, sepsis, following trauma, multiple blood transfusions, severe burns, severe pancreatitis, near-drowning, drug reactions, or inhalation injuries.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 149
Incorrect
-
A 47-year-old male smoker, who had been self-medicating with oral steroids for the last two years due to persistent breathlessness presented to the doctor complaining of a productive cough, fever and chest pain. A chest X-ray revealed bilateral patchy opacities. He was diagnosed with bilateral bronchopneumonia. Which of these organisms is most probably causing these findings?
Your Answer:
Correct Answer: Nocardia asteroides
Explanation:Nocardia is a Gram-positive aerobic actinomycete. Several species have been identified but the most common human pathogen is Nocardia asteroides. The predominant clinical finding in the majority of patients affected by nocardiosis is pulmonary disease. Predisposing factors for pulmonary nocardiosis include leukaemia, human immunodeficiency virus (HIV) infection, organ transplantation, diabetes and receiving prolonged corticosteroids.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 150
Incorrect
-
A 76 year old man who presented with lower back pain is diagnosed with prostatic carcinoma that has metastasized to his lumber spine. Which of the following markers is characteristically elevated?
Your Answer:
Correct Answer: PSA
Explanation:Spread of prostatic carcinoma is common to the lumbar spine and pelvis. This results in osteoblastic metastases that will present as lower back pain with increased alkaline phosphatase, prostatic acid phosphates and PSA. PSA is more specific and a PSA > 10 ng/ml for any age is worrisome.
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This question is part of the following fields:
- Neoplasia; Urology
- Pathology
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Question 151
Incorrect
-
Choose the most correct answer regarding the obturator internus muscle.
Your Answer:
Correct Answer: It emerges from the pelvis through the lesser sciatic foramen
Explanation:The obturator internus arises from the inner surface of the anterolateral wall of the pelvis and the pelvic surface of the obturator membrane. The fibres converge rapidly towards the lesser sciatic foramen and end in four or five tendinous bands and leave the pelvis through the lesser sciatic foramen.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 152
Incorrect
-
A 44-year old gentleman presented to the hospital in congestive cardiac failure. On further investigation, he was found to have a right-sided retroperitoneal mass. On enquiry, he gave a history of intermittent hypertensive attacks. 24-hour urine specimen revealed raised metanephrine and vanillylmandelic acid levels. What is the likely diagnosis?
Your Answer:
Correct Answer: Pheochromocytoma
Explanation:A neuroendocrine tumour of the chromaffin cells in adrenal medulla, pheochromocytoma secretes excessive catecholamines – adrenaline (epinephrine) and noradrenaline (norepinephrine). Pheochromocytomas are also known as the ‘10% tumour’. This is because 10% of them are bilateral, 10% are malignant, and 10% are extra-adrenal. Extra-adrenal paragangliomas (also known as extra-adrenal pheochromocytomas) are less common than pheochromocytomas and arise in the ganglia of sympathetic nervous system. Around 25% of pheochromocytomas are familial. Symptoms are described as feeling of ‘impending doom’, and include tachycardia, hypertension, palpitations, anxiety, headaches and pallor. Orthostatic hypertension is typically seen where there is a more than 100 mmHg fall in systolic pressure when the patient stands up. Pheochromocytomas can also lead to malignant hypertension. Diagnosis is by measurement of catecholamines and metanephrines in blood or in 24-hour urine, after exclusion of other possible causes such as stress, hypoglycaemia and drugs (methyldopa, dopamine agonists, ganglion-blocking antihypertensive). Imaging is also needed to localize the tumour. Localization of the tumour can also be done by Iodine-131 meta-iodobenzylguanidine (I131-MIBG) imaging.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 153
Incorrect
-
Which of the following foramina provides a passage through which the vestibulocochlear nerve, passes?
Your Answer:
Correct Answer: Internal acoustic meatus
Explanation:The internal auditory meatus is a canal within the petrous part of the temporal bone of the skull between the posterior cranial fossa and the inner ear. It provides a passage through which the vestibulocochlear nerve, the facial nerve, and the labyrinthine artery (an internal auditory branch of the basilar artery) can pass from inside the skull to structures of the inner ear and face.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 154
Incorrect
-
The vagus nerve passes through which of the following foramen?
Your Answer:
Correct Answer: Jugular foramen
Explanation:The jugular foramen is a large foramen in the base of the skull. It is located behind the carotid canal and is formed in front by the petrous portion of the temporal bone, and behind by the occipital bone. Cranial nerves IX, X, and XI and the internal jugular vein pass through the jugular foramen.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 155
Incorrect
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A 15-day old baby was brought to the emergency department with constipation for 4 days. On examination, the abdomen of the baby was found to be distended and tender all over. No bowel sounds were heard. A sigmoid colon biopsy was carried out, which showed absent ganglion cells. What is the diagnosis?
Your Answer:
Correct Answer: Hirschsprung’s disease
Explanation:Hirschsprung’s disease is characterized by congenital absence of the autonomic plexus (Meissner’s and Auerbach’s plexus) in the intestinal wall. Usually limited to the distal colon, it can occasionally involve the entire colon or even the small bowel. There is abnormal or absent peristalsis in the affected segment, resulting in continuous spasm of smooth muscle and partial/complete obstruction. This causes accumulation of intestinal contents and dilatation of proximal segment. Skip lesions are highly uncommon. This disease is seen early in life with 15% patients presenting in first month, 60% by 1 year of age and 85% by the age of 4 years. Symptoms include severe and complete constipation, abdominal distension and vomiting. Patients with involvement of ultra-short segments might have mild constipation with intervening diarrhoea. In older children, symptoms include failure to thrive, anorexia, and lack of an urge to defecate. On examination, an empty rectum is revealed with stool palpable high up in the colon. If not diagnosed in time, it can lead to Hirschsprung’s enterocolitis (toxic megacolon), which can be fulminant and lead to death. Diagnosis involves a barium enema or a rectal suction biopsy. Barium enema shows a transition in diameter between the dilated, normal colon proximal to the narrowed, affected distal segment. It is to be noted that barium enema should be done without prior preparation, which can dilate the abnormal segment, leading to a false-negative result. A 24-hour post-evacuation film can be obtained in the neonatal period – if the colon is still filled with barium, there is a high likelihood of Hirschsprung’s disease. Full-thickness rectal biopsy is diagnostic by showing the absence of ganglion cells. Acetylcholinesterase staining can be done to highlight the enlarged nerve trunks. Abnormal innervation can also be demonstrated by rectal manometry.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 156
Incorrect
-
A 35-year-old woman in her 37th week of pregnancy complains of urinary incontinence. She is most likely to have:
Your Answer:
Correct Answer: Stress incontinence
Explanation:Urinary incontinence is the involuntary excretion of urine from one’s body. It is often temporary and it almost always results from an underlying medical condition. Several types include:
– Stress incontinence is the voiding of urine following increased abdominal pressure e.g. laughing, coughing, pregnancy etc. It is the most common form of incontinence in women, most commonly due to pelvic floor muscle weakness, physical changes from pregnancy, childbirth and menopause. In men it is a common problem following a prostatectomy. Most lab results such as urine analysis, cystometry and postvoid residual volume are normal.
– Urge incontinence is involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate. The most common cause of urge incontinence are involuntary and inappropriate detrusor muscle contractions.
– Functional incontinence – occurs when a person does not recognise the need to go to the toilet, recognise where the toilet is or get to the toilet in time. The urine loss may be large. Causes of functional incontinence include confusion, dementia, poor eyesight, poor mobility, poor dexterity or unwillingness. t
– Overflow incontinence – sometimes people find that they cannot stop their bladders from constantly dribbling or continuing to dribble for some time after they have passed urine.
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This question is part of the following fields:
- Physiology
- Renal
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Question 157
Incorrect
-
A patient is brought to the accident and emergency department. He is said to have been involved in a mall explosion. Chest imaging reveals metal fragments in his thoracic cavity. He also has a pericardial effusion suggestive of a pericardial tear. An emergency thoracotomy is done which revealed a tear of the pericardium inferiorly. The surgeon began to explore for fragments in the pericardial sac with his hand from below the apex. He slips his fingers upward and to the right within the sac until they were stopped by the cul-de-sac formed by the pericardial reflection near the base of the heart. His finger tips were now in the:
Your Answer:
Correct Answer: Oblique pericardial sinus
Explanation:Transverse sinus: part of pericardial cavity that is behind the aorta and pulmonary trunk and in front of the superior vena cava separating the outflow vessels from the inflow vessels.
Oblique pericardial sinus: is behind the left atrium where the visceral pericardium reflects onto the pulmonary veins and the inferior vena cava. Sliding a finger under the heart will take you to this sinus.
Coronary sinus: large vein that drains the heart into the right atrium. Located on the surface of the heart.
Coronary sulcus: groove on the heart demarcating the atria from the ventricles.
Costomediastinal recess: part of the pleural sac where the costal pleura transitions to become the mediastinal pleura.
Sulcus terminalis: a groove between the right atrium and the vena cava.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 158
Incorrect
-
A 22-year old man presented with a mass in his left scrotum which was more prominent when standing and felt like a 'bag of worms'. Examination revealed a non-tender mass along the spermatic cord. Also, the right testis was larger than the left testis. What is the likely diagnosis?
Your Answer:
Correct Answer: Varicocele
Explanation:Varicocele refers to dilatation and increased tortuosity of the pampiniform plexus – which is a network of veins found in spermatic cord that drain the testicle. Defective valves or extrinsic compression can result in outflow obstruction and cause dilatation near the testis. Normal diameter of the small vessels ranges from 0.5 – 1.5mm. A varicocele is a dilatation more than 2mm.
The plexus travels from the posterior aspect of testis into the inguinal canal with other structures forming the spermatic cord. They then form the testicular veins out of which the right testicular vein drains into the inferior vena cava and the left into the left renal vein.
It affects 15-20% men, and 40% of infertile males. Usually diagnosed in 15-25 years of age, they are rarely seen after 40 years of age. Because of the vertical path taken by the left testicular vein to drain into left renal vein, 98% idiopathic varicoceles occur on the left side. It is bilateral in 70% cases. Right-sided varicoceles are rare.
Symptoms include pain or heaviness in the testis, infertility, testicular atrophy, a palpable mass, which is non-tender and along the spermatic cord (resembling a ‘bag of worms’). The testis on the affected side might be smaller.
Diagnosis can be made by ultrasound. Provocative measures such as Valsalva manoeuvre or making the patient stand up to increase the dilatation by increasing the intra-abdominal venous pressure.
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This question is part of the following fields:
- Pathology
- Urology
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Question 159
Incorrect
-
If a 68-year-old man is diagnosed with a testicular seminoma that reaches the tunica albuginea and involves the tunica vaginalis, with retroperitoneal lymph nodes greater than 5cm, LDH 1.4 times the reference levels, β-hCG 4250 mIU/ml and AFP 780 ng/ml, what's the clinical stage in this case?
Your Answer:
Correct Answer: Stage IIC
Explanation:According to the AJCC, the clinical staging for testicular seminoma is:
Stage IA: T1 N0 M0 S0
Stage IB: T2/3/4 N0 M0 S0
Stage IC: any T N0 M0 S1/2/3
Stage IIA: any T N1 M0 S0/1
Stage IIB: any T N2 M0 S0/1
Stage IIC: any T N3 M0 S0/1
Stage IIIA: any T any N M1a S0/1
Stage IIIB: any T any N M0/1a S2
Stage IIIC: any T any N M1a/1b S3.
The patient in this case has IIC stage -
This question is part of the following fields:
- Pathology
- Urology
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Question 160
Incorrect
-
Two boys were playing when one of them brought the forearm of the other behind his back. This resulted in a stretching of the lateral rotator of the arm. Which of the following muscles was most likely to have been involved?
Your Answer:
Correct Answer: Infraspinatus
Explanation:There are two lateral rotators of the arm, the infraspinatus and the teres minor muscles. The infraspinatus muscle receives nerve supply from C5 and C6 via the suprascapular nerve, whilst the teres minor is supplied by C5 via the axillary nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 161
Incorrect
-
An 18 -year-old female is diagnosed with folliculitis in the left axilla. What is the most likely organism that could cause this condition?
Your Answer:
Correct Answer: Staphylococcus aureus
Explanation:Folliculitis is the inflammation of the hair follicles. It is usually caused by Staphylococcus infection.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 162
Incorrect
-
Which of the following is the source of blood supply to the artery of the round ligament at the head of the femur?
Your Answer:
Correct Answer: Obturator artery
Explanation:The posterior branch of the obturator artery provides an articular branch to the head of the femur.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 163
Incorrect
-
An operation to remove a segment of the oesophagus through a right thoracotomy is complicated when a tear develops in a large venous structure in the posterior mediastinum that empties into the superior vena cava. Which of the following structures is likely to be injured?
Your Answer:
Correct Answer: Azygos vein
Explanation:The azygos vein is formed by the union of the right subcostal veins and the ascending lumbar veins at the level of the 12th thoracic vertebra. It enters the thorax through the aortic hiatus to ascend in the posterior mediastinum and arching over the right main bronchus posteriorly at the root of the right lung to join the superior vena cava before it pierces the pericardium.
The basilic vein is a vein on the medial aspect of the arm that ascends to become the axillary vein.
The cephalic vein is also a vein of the arm.
The external jugular and brachiocephalic vein are not in the posterior mediastinum.
The median cubital vein is found in the cubital fossa of the arm.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 164
Incorrect
-
The muscle that depresses the glenoid fossa directly is the:
Your Answer:
Correct Answer: Pectoralis minor
Explanation:Situated at the upper part of the thorax beneath the pectoralis major, is a thin pectoralis minor, triangular muscle. It originates from the third, fourth and fifth ribs, near the cartilage and from the aponeurosis which covers the intercostals. These fibres move upwards and laterally to join and form a flat tendon. This is inserted into the medial border and upper surface of the coracoid process of the scapula. Through this medial anterior thoracic nerve, fibres from the pectoralis minor are received from the eighth cervical and first thoracic nerves. This pectoralis minor pushes down on the point of the shoulder (glenoid fossa), drawing the scapula downward and medially towards the thorax which throws the inferior angle backwards.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 165
Incorrect
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Question 166
Incorrect
-
A young girl injured her arm following a fall down the steps On examination, it was found that her left proximal radioulnar joint had dislocated and the annular ligament was stretched. This will make which movement extremely painful?
Your Answer:
Correct Answer: Supination
Explanation:Supination is the rotation of the forearm so that the palm of the hand faces anteriorly. This is performed by the biceps brachii and supinator of the extensor muscles of the thumb. The opposite action of moving the palm from an anterior-facing position to a posterior-facing position is called pronation. Pronation is performed by the pronator teres and pronator quadratus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 167
Incorrect
-
Difficulty in retracting the foreskin of the penis in an uncircumcised male is known as:
Your Answer:
Correct Answer: Phimosis
Explanation:Phimosis is the inability to fully retract the foreskin of the penis in an uncircumcised male. It can be physiological in infancy, in which it could be referred to as ‘developmental non-retractility of the foreskin. However, it is almost always pathological in older children and men. Causes include chronic inflammation (e.g. balanoposthitis), multiple catheterisations, or forceful foreskin retraction. One of the causes is chronic balanitis xerotica obliterans. It leads to development of a ring of indurated tissue near the tip of the prepuce, which prevents retraction. Contributory factors include infections, hormonal and inflammatory factors. The recommended treatment includes circumcision.
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This question is part of the following fields:
- Pathology
- Urology
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Question 168
Incorrect
-
Which of the following muscle divide the posterior triangle of the neck into the occipital and the subclavian triangle?
Your Answer:
Correct Answer: Inferior belly of the omohyoid
Explanation:The posterior triangle (or lateral cervical region) is a region of the neck bounded in front by the sternocleidomastoid; behind, by the anterior margin of the trapezius; inferiorly by the middle third of the clavicle and superiorly by the occipital bone. The posterior triangle is crossed, about 2.5 cm above the clavicle, by the inferior belly of the omohyoid muscle, which divides the space into two triangles: an upper or occipital triangle and a lower or subclavian triangle (or supraclavicular triangle).
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 169
Incorrect
-
Which of the following statements is true of Colles’ fracture?
Your Answer:
Correct Answer: Is a cause of carpal tunnel syndrome
Explanation:Colles’ fracture is a distal fracture of the radius that is a known cause of carpal tunnel syndrome (compression of the median nerve in the carpal tunnel). It rarely results in ulnar nerve compression. A Colles’ fracture is extra-articular and does not extend into the wrist joint, otherwise this would make it an intra-articular fracture (Barton’s fracture). The distal fragment in a Colles’ fracture is displaced dorsally, unlike in a Smith’s fracture where the distal fragment is displaced volarly (ventrally). Associated fracture of the ulnar styloid process may occur and is a common associated injury.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 170
Incorrect
-
For calculation of cardiac output by Fick's principle, which of the following vessels is the best source of venous blood to determine the arterial-to-venous oxygen tension difference?
Your Answer:
Correct Answer: Pulmonary artery
Explanation:Fick’s principle states that the total uptake (or release) of a substance by peripheral tissues is equal to the product of the blood flow to the peripheral tissues and the arterial– venous concentration difference (gradient) of the substance. It is used to measure the cardiac output, and the formula is Cardiac output = oxygen consumption divided by arteriovenous oxygen difference. Assuming there are no shunts across the pulmonary system, the pulmonary blood flow equals the systemic blood flow. The arterial and venous blood oxygen content is measured by sampling from the pulmonary artery (low oxygen content) and pulmonary vein (high oxygen content). Peripheral arterial blood is used as a surrogate for the pulmonary vein.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 171
Incorrect
-
Loperamide is a drug used to treat diarrhoea. What is the mechanism of action of loperamide?
Your Answer:
Correct Answer: Opiate agonist
Explanation:Loperamide is an opioid-receptor agonist and acts on the mu opioid receptors in the myenteric plexus of large intestine. It works by decreasing the motility of the circular and longitudinal smooth muscles of the intestinal wall. It is often used for this purpose in gastroenteritis, inflammatory bowel disease, and short bowel syndrome.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 172
Incorrect
-
During the fetal stage, the mesonephric tubules gives rise to the?
Your Answer:
Correct Answer: Wolffian duct
Explanation:The development of the kidney proceeds through a series of successive phases, each marked by the development of a more advanced kidney: the pronephros, mesonephros, and metanephros. The development of the pronephric duct proceeds in a cranial-to-caudal direction. As it elongates caudally, the pronephric duct induces nearby intermediate mesoderm in the thoracolumbar area to become epithelial tubules called mesonephric tubules. Each mesonephric tubule receives a blood supply from a branch of the aorta, ending in a capillary tuft analogous to the glomerulus of the definitive nephron. The mesonephric tubule forms a capsule around the capillary tuft, allowing for filtration of blood. This filtrate flows through the mesonephric tubule and is drained into the continuation of the pronephric duct, now called the mesonephric duct or Wolffian duct. The nephrotomes of the pronephros degenerate while the mesonephric duct extends towards the most caudal end of the embryo, ultimately attaching to the cloaca.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 173
Incorrect
-
A 30-year-old woman feels thirsty. This thirst is probably due to:
Your Answer:
Correct Answer: Increased level of angiotensin II
Explanation:Thirst is the basic need or instinct to drink. It arises from a lack of fluids and/or an increase in the concentration of certain osmolites such as salt. If the water volume of the body falls below a certain threshold or the osmolite concentration becomes too high, the brain signals thirst. Excessive thirst, known as polydipsia, along with excessive urination, known as polyuria, may be an indication of diabetes. Angiotensin II is a hormone that is a powerful dipsogen (i.e. it stimulates thirst) that acts via the subfornical organ. It increases secretion of ADH in the posterior pituitary and secretion of ACTH in the anterior pituitary.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 174
Incorrect
-
A 25-year-old woman complains of generalised swelling and particularly puffiness around the eyes which is worst in the morning. Laboratory studies showed:
Blood urea nitrogen (BUN) = 30 mg/dl
Creatinine = 2. 8 mg/dl
Albumin = 2. 0 mg/dl
Alanine transaminase (ALT) = 25 U/l
Bilirubin = 1 mg/dl
Urine analysis shows 3+ albumin and no cells.
Which of the following is the most likely diagnosis?Your Answer:
Correct Answer: Nephrotic syndrome
Explanation:Nephrotic syndrome is a disorder in which the glomeruli have been damaged, characterized by:
– Proteinuria (>3.5 g per 1.73 m2 body surface area per day, or > 40 mg per square meter body surface area per hour in children)
– Hypoalbuminemia (< 2,5 g/dl) – Hyperlipidaemia, and oedema (generalized anasarca).
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This question is part of the following fields:
- Physiology
- Renal
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Question 175
Incorrect
-
A 55- year old male patient with cancer of the head of the pancreas was to undergo whipple's operation to have the tumour removed. During the surgery, the surgeon had to ligate the inferior pancreaticoduodenal artery to stop blood supply to the head of the pancreas. Which of the following arteries does the inferior pancreaticoduodenal artery branch from?
Your Answer:
Correct Answer: Superior mesenteric artery
Explanation:The inferior pancreaticoduodenal artery is a branch of the superior mesenteric artery or from the first intestinal branch of the superior mesenteric artery. Once given off, it runs to the right between the pancreatic head and the duodenum and then ascends to form an anastomosis with the superior pancreaticoduodenal artery.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 176
Incorrect
-
Question 177
Incorrect
-
A teacher had varicosities in the region of the small saphenous vein. Which of the following is true about that vein?
Your Answer:
Correct Answer: Has nine to twelve valves
Explanation:It is known that the small saphenous vein has nine to twelve valves along its course. This vein begins as a direct continuation of the lateral marginal vein posterior to the lateral malleolus. It is superficially situated but closer to its termination, perforates the deep fascia in the lower part of the popliteal fossa to end in the popliteal vein.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 178
Incorrect
-
A TRUE statement regarding abolition of the cephalic phase of pancreatic secretion is that it:
Your Answer:
Correct Answer: Will result after vagotomy
Explanation:Recognition and integration of the sight, smell and taste of food triggers the cephalic phase of pancreatic secretion, causing an increase in pancreatic HCO3- and enzyme secretion. The degree of enzyme secretion in this phase is about 50% of the maximal response seen with exogenous CCK and secretin. The vagus nerve regulates the secretion through the cholinergic fibres innervating the acinar cells of the pancreas, and through peptidergic nerve fibres, which innervate ductal cells.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 179
Incorrect
-
An organ transplant patient may be at risk of developing which type of cancer?
Your Answer:
Correct Answer: Skin cancer
Explanation:The most common malignancies encountered in the post–solid organ transplant setting are non-melanoma skin cancers, post-transplant lymphoproliferative disorders and Kaposi’s sarcoma (KS). The pathogenesis of these tumours is likely related to the immunosuppressive drugs used post-transplantation and subsequent viral infection.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 180
Incorrect
-
Calculate the resistance of the artery if the pressure at one end is 60 mmHg, pressure at the other end is 20 mm Hg and the flow rate in the artery is 200 ml/min.
Your Answer:
Correct Answer: 0.2
Explanation:Flow in any vessel = Effective perfusion pressure divided by resistance, where effective perfusion pressure is the mean intraluminal pressure at the arterial end minus the mean pressure at the venous end. Thus, in the given problem, resistance = (60 − 20)/200 = 0.2 mmHg/ml per min.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 181
Incorrect
-
A patient sustained an iatrogenic injury to one of the structures passing through the deep inguinal ring. This was during an operation to repair an inguinal hernia. Which structure is most likely to be injured?
Your Answer:
Correct Answer: Round ligament of the uterus
Explanation:The deep inguinal ring transmits the spermatic cord in the man and the round ligament of the uterus in the female. It is bound below and medially by the inferior epigastric vessels (so these don’t go through it).
The ilioinguinal nerve, although it courses through the inguinal canal, does not pass through it.
The iliohypogastric nerves run between the internal oblique and transversus abdominis in the abdominal wall, piercing the internal oblique at the anterior superior iliac spine to travel just deep to the external oblique.
The inferior epigastric artery runs between the transversus abdominis and the peritoneum forming the lateral umbilical fold.
The medial umbilical ligament is the obliterated umbilical artery that it lies within the medial umbilical fold of peritoneum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 182
Incorrect
-
Routine evaluation of a 38 year old gentleman showed a slightly lower arterial oxygen [pa(O2)] than the alveolar oxygen [pA(O2)]. This difference is:
Your Answer:
Correct Answer: Is normal and due to shunted blood
Explanation:Blood that bypasses the ventilated parts of lung and enters the arterial circulation directly is known as shunted blood. It happens in normal people due to mixing of arterial blood with bronchial and some myocardial venous blood (which drains into the left heart). Diffusion limitation and reaction velocity with haemoglobin are immeasurably small. CO2 unloading will not affect the difference between alveolar and arterial p(O2). A large VSD will result in much lower arterial O2 as compared to alveolar O2.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 183
Incorrect
-
Which muscle in the neck divides the neck into two large triangles?
Your Answer:
Correct Answer: Sternocleidomastoid
Explanation:The sternocleidomastoid muscle is an important landmark in the neck as it divides the neck into two; anterior and posterior triangles. These triangles help in the location of the structures of the neck including the carotid artery, head and neck lymph nodes, accessory nerve and the brachial plexus. It originates from the manubrium and medial portion of the clavicle and inserts on the mastoid process of the temporal bone, superior nuchal line. The sternocleidomastoid receives blood supply from the occipital artery and the superior thyroid artery. It is innervated by the accessory nerve (motor) and cervical plexus (sensory).
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 184
Incorrect
-
Which of these antibiotics is the first choice treatment for infections caused by Pseudomonas aeruginosa?
Your Answer:
Correct Answer: Piperacillin
Explanation:Piperacillin is an extended-spectrum beta-lactam antibiotic of the ureidopenicillin class. It is normally used with a beta-lactamase inhibitor such as tazobactam. The combination has activity against many Gram-positive and Gram-negative pathogens and anaerobes, including Pseudomonas aeruginosa. Piperacillin is sometimes referred to as an anti-pseudomonal penicillin.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 185
Incorrect
-
A construction worker is brought to the A&E after a fall on site. The patient is conscious but complains of inability to feel his legs. A neurological examination reveals that he has no cutaneous sensation from his umbilicus to his toes. What is the likely level of the spinal cord that is injured?
Your Answer:
Correct Answer: T10
Explanation:The umbilicus has a relatively consistent position in humans and thus serves as an important land mark. The skin around the waist at the level of the umbilicus is supplied by the tenth thoracic spinal nerve (T10 dermatome).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 186
Incorrect
-
The transverse colon has two curvatures known as the colic flexures on each side of its lateral ends, the right and left. The left colic flexure found on the side of the descending colon is attached to an organ superiorly by a mesenteric ligament. Which organ is this?
Your Answer:
Correct Answer: Spleen
Explanation:The left colic flexure is the bend of the transverse colon as it continues to form the descending colon on the left upper quadrant. The spleen is located on the superior aspect of the left colic flexure. It is commonly referred to as the splenic flexure because of its relation o the spleen superiorly.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 187
Incorrect
-
A young female in the 15th week of pregnancy presented to the emergency department with the passage of grape-like masses per vagina. Dilatation and curettage was done and microscopy revealed large avascular villi with trophoblastic proliferation. Which one of the following investigations is best recommended for her follow-up?
Your Answer:
Correct Answer: Serum β-hCG
Explanation:Trophoblast is the layer of cells surrounding the blastocyst and that later develops into the chorion and amnion. Gestational trophoblastic disease is a tumour arising from this trophoblast. It can occur during or after either an intrauterine or ectopic pregnancy. If it occurs in a pregnant woman, it usually leads to spontaneous abortion, eclampsia or fetal death. It can be either malignant or benign.
In suspected cases, investigations include measurement of serum beta subunit of human chorionic gonadotrophin (β-hCG) and pelvic ultrasound. Confirmatory test is a biopsy. Post-removal, the disease is classified clinically to assess further treatment. To assess the presence of metastases, further work-up includes computed tomography of the brain, chest, abdomen and pelvis. Chemotherapy is usually needed for persistent disease. If at least three consecutive, weekly serum β-hCG measurements are normal, treatment is considered successful. Follow-up is also done by measuring β-hCG.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 188
Incorrect
-
A 45-year-old pregnant woman develops high blood pressure at 20 weeks. She complains of headaches and swollen feet, and a test reveals proteinuria (350 mg/day). Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Pre-eclampsia
Explanation:Pre-eclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure (two separate readings taken at least 6 h apart of 140/90 or more) and often a significant amount of protein in the urine (>300 mg of protein in a 24-h urine sample). While blood pressure elevation is the most visible sign of the disease, it involves generalised damage to the maternal endothelium of the kidneys and liver, with the release of vasopressive factors only secondary to the original damage. Pre-eclampsia may develop at varying times within pregnancy and its progress differs among patients; most cases present pre-term. It has no known cure apart from ending the pregnancy (induction of labour or abortion). It may also present up to 6 weeks post partum. Risk factors for pre-eclampsia include obesity, prior hypertension, older age, and diabetes mellitus.
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This question is part of the following fields:
- Physiology
- Renal
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Question 189
Incorrect
-
A 12-year old girl was brought to the hospital with recurrent headaches for 6 months. Her physical examination revealed no abnormality. A CT scan of the head revealed a suprasellar mass with calcifications, eroding the surrounding sella turcica. The lesion is likely to represent:
Your Answer:
Correct Answer: Craniopharyngioma
Explanation:Craniopharyngiomas (also known as Rathke pouch tumours, adamantinomas or hypophyseal duct tumours) affect children mainly between the age of 5 and 10 years. It constitutes 9% of brain tumours affecting the paediatric population. These are slow-growing tumours which can also be cystic, and arise from the pituitary stalk, specifically the nests of epithelium derived from Rathke’s pouch. Histologically, this tumour shows nests of squamous epithelium which is lined on the outside by radially arranged cells. Calcium deposition is often seen with a papillary type of architecture.
ACTH-secreting pituitary adenomas are rare and mostly microadenomas. Paediatric astrocytoma’s usually occur in the posterior fossa. Although null cell adenomas can cause mass effect and give rise to the described symptoms, they are not suprasellar. Prolactinomas can also show symptoms of headache and disturbances in the visual field, however they are known to be small and slow-growing.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 190
Incorrect
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Arterial blood gas analysis of a man admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD) showed the following: pH = 7.28, p(CO2) = 65.5 mmHg, p(O2)= 60 mmHg and standard bicarbonate = 30.5 mmol/l. This patient had:
Your Answer:
Correct Answer: Respiratory acidosis
Explanation:Acidosis with high p(CO2) and normal standard bicarbonate indicates respiratory acidosis, commonly seen in acute worsening of COPD patients. Respiratory acidosis occurs due to alveolar hypoventilation which leads to increased arterial carbon dioxide concentration (p(CO2)). This in turn decreases the HCO3 –/p(CO2) and decreases pH. In acute respiratory acidosis, the p(CO2) is raised above the upper limit of normal (over 45 mm Hg) with a low pH. However, in chronic cases, the raised p(CO2) is accompanied with a normal or near-normal pH due to renal compensation and an increased serum bicarbonate (HCO3 – > 30 mmHg).
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 191
Incorrect
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A 10-year-old boy was sent for an x-ray of the leg because he was complaining of pain and swelling. The x-ray showed the classic sign of Codman's triangle. What is the most likely diagnosis of this patient?
Your Answer:
Correct Answer: Osteosarcoma
Explanation:Codman’s triangle is the triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone. The main causes for this sign are osteosarcoma, Ewing’s sarcoma, eumycetoma, and a subperiosteal abscess.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 192
Incorrect
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C5a (a complement component) is a potent?
Your Answer:
Correct Answer: Anaphylotoxin
Explanation:C5a is a strong chemoattractant as well as an anaphylotoxin and is involved in the recruitment of inflammatory cells such as neutrophils, eosinophils, monocytes, and T lymphocytes. It is also involved in activation of phagocytic cells, release of granule-based enzymes and generation of oxidants. All of which contribute to innate immune functions.
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This question is part of the following fields:
- General
- Physiology
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Question 193
Incorrect
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An explorative laparotomy is done on a 23 year old following a gunshot abdominal injury through the right iliac fossa. It is found that the ileocolic artery is severed and the bullet had perforated the caecum. From which branch does the ileocolic artery originate?
Your Answer:
Correct Answer: Superior mesenteric artery
Explanation:Ileocolic artery branches off from the superior mesenteric artery. It then divides to give a superior and inferior branch.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 194
Incorrect
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A 78-year-old woman was brought to the emergency department with decreased consciousness, weakness and dehydration. Which serum electrolyte would most likely be low in this patient?
Your Answer:
Correct Answer: Na+
Explanation:Hyponatremia is a sodium level below 135 mEq/L. Signs and symptoms may include: nausea with vomiting, fatigue, headache or confusion, cramps or spasm, irritability and restlessness and severe cases may lead to seizures and comma.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 195
Incorrect
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A 40-year old lady presented to the hospital with fever and mental confusion for 1 week. On examination, she was found to have multiple petechiae all over her skin and mucosal surfaces. Blood investigations revealed low platelet count and raised urea and creatinine. A platelet transfusion was carried out, following which she succumbed to death. Autopsy revealed pink hyaline thrombi in myocardial arteries. What is the likely diagnosis?
Your Answer:
Correct Answer: Thrombotic thrombocytopenic purpura
Explanation:Hyaline thrombi are typically associated with thrombotic thrombocytopenic purpura (TTP), which is caused by non-immunological destruction of platelets. Platelet transfusion is contraindicated in TTP. Platelets and red blood cells also get damaged by loose strands of fibrin deposited in small vessels. Multiple organs start developing platelet-fibrin thrombi (bland thrombi with no vasculitis) typically at arteriocapillary junctions. This is known as ‘thrombotic microangiopathy’. Treatment consists of plasma exchange.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 196
Incorrect
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The thoracic duct :
Your Answer:
Correct Answer: varies in length from 38 to 45 cm
Explanation:The thoracic duct is the main drainage of lymph in the body. It varies in length from 38 to 45 cm and extends from the second lumbar vertebra to the root of the neck.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 197
Incorrect
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The superior pancreaticoduodenal artery, the artery that supplies blood to the pancreas and the duodenum, is a branch of the:
Your Answer:
Correct Answer: Gastroduodenal artery
Explanation:The superior pancreaticoduodenal artery together with the right gastroepiploic artery form the two branches of the gastroduodenal artery which divides at the lower border of the duodenum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 198
Incorrect
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Which of the following is responsible for the activation of pepsinogen released in the stomach?
Your Answer:
Correct Answer: Acid pH and pepsin
Explanation:Pepsinogen is the inactive precursor of pepsin. Once secreted, it comes in contact with hydrochloric acid and pepsin, previously formed, and undergoes cleavage to form active pepsin.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 199
Incorrect
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Raised alkaline phosphatase and positive antimitochondrial antibody indicates which of the following conditions presenting with pruritus?
Your Answer:
Correct Answer: Primary biliary cirrhosis
Explanation:An autoimmune disease, primary biliary cirrhosis results in destruction of intrahepatic bile ducts. This leads to cholestasis, cirrhosis and eventually, hepatic failure. Symptoms includes fatigue, pruritus and steatorrhea. Increased IgM levels, along with antimitochondrial antibodies are seen in the serum. Liver biopsy is diagnostic, and also aids in staging of disease.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 200
Incorrect
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How are amino acids transported across the luminal surface of the small intestinal epithelium?
Your Answer:
Correct Answer: Co-transport with sodium ions
Explanation:Once complex peptides are broken down into amino acids by the peptidases present in the brush border of small intestine, they are ready for absorption by at least four sodium-dependent amino acid co-transporters – one each for acidic, basic, neutral and amino acids, present on the luminal plasma membrane. These transporters first bind sodium and can then bind the amino acids. Thus, amino acid absorption is totally dependent on the electrochemical gradient of sodium across the epithelium. The basolateral membrane in contrast, possesses additional transporters to carry amino acids from the cell into the blood, but these are sodium-independent.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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